HB1448

SECTION 1. The legislature finds that, according to the department of health, more than one hundred ten thousand residents are living with asthma and approximately one third of those are children. The chronic respiratory disease occurs most commonly among children eleven years of age and younger. Every year, some five thousand people in Hawaii visit emergency rooms due to asthma and another one thousand five hundred are hospitalized. Infants and very young children make up the majority of asthma-related medical emergencies and hospitalizations. Every year, asthma costs the State approximately $4,200,000 in emergency room visits and approximately $14,000,000 in hospitalizations. Although the asthma mortality rate has declined over the past ten years, there was an average of twenty-two deaths per year from asthma in Hawaii between 2013 and 2015.

Because asthma attacks can occur at any time and often without warning, children with asthma should always have access to medication that can quickly reverse the blockages in their lungs. This life-saving medication, called a short-acting bronchodilator, is easy to administer, inexpensive, and very safe. Unfortunately, when children do not have asthma medication, which can occur for a variety of reasons such as forgetting it or not being able to afford it, schools have few options. A parent may not be immediately accessible or close enough to respond promptly. Even if they can, there is a delay during which the asthma attack often gets worse and, in such cases, the school will need to call 9-1-1. Doing so likely leads to an ambulance transport cost and an emergency department visit costing thousands more. These events take children out of the classroom for days at a time and further impede their learning. It also overtaxes emergency room resources with a condition that could be solved quickly and efficiently if bronchodilators had been available.

The purpose of this Act is to authorize the department of education to stock bronchodilators for emergency use during respiratory distress and authorize department employees to volunteer to administer bronchodilators.

SECTION 2. Chapter 302A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§302A- Bronchodilators stock supply. A school may maintain a stock supply of bronchodilators to be administered by a school nurse or other authorized employees and agents volunteering to administer to any student or individual as needed for actual or perceived asthma episodes. A school that intends to maintain a stock supply of bronchodilators and spacers in a school setting or at related activities shall:

(1) Develop a protocol related to the training of school employees, the maintenance and location of the bronchodilators, and immediate and long-term follow up to the administration of the medication, including making a 9-1-1 emergency call;

(2) Ensure that the bronchodilator and spacer be prescribed by a physician, advanced practice registered nurse, or physician assistant. The school shall be designated as the patient, and each prescription for a bronchodilator shall be filled by a licensed pharmacy or manufacturer. Schools may with a valid prescription, accept donated bronchodilators, devices, and device components and apply for grants to purchase bronchodilators, devices, and device components. An authorized licensed prescriber may refill any used or expired prescriptions to be maintained for use when deemed necessary. All expired medication shall be discarded in accordance with proper procedure;

(3) Only allow school nurses and authorized employees and agents that have completed appropriate training, as designated in the protocol, to administer the stock bronchodilator;

(4) Store stock bronchodilators in a secure and easily accessible location, but an unlocked location known to the school nurse and all school staff designated to administer the bronchodilator in the case of the nurse's absence;

(5) Ensure that a school nurse or other authorized employees and agents administer, in good faith, the bronchodilator to any student or individual who is experiencing a potential life-threatening asthma episode, such as an asthma attack or asthmatic symptoms; and

(6) Inform parents or guardians about the potential use of the bronchodilator in a respiratory emergency. The school shall make the protocol available upon request."

SECTION 3. Section 302A-1164, Hawaii Revised Statutes, is amended to read as follows:

"§302A-1164 Self-administration of medication by student and emergency administration; self-testing and self-management of diabetes by student; assistance with diabetes testing; blood glucose monitoring by student; assistance with blood glucose monitoring[;] and bronchodilators; permitted. (a) The department shall permit:

(1) The self-administration of:

(A) Medication by a student for asthma, anaphylaxis, diabetes, or other potentially life‑threatening illnesses; and

(B) Blood glucose monitoring by a student; and

(2) Department employees and agents to volunteer to administer:

(A) Insulin or assist a student in administering insulin via the insulin delivery system that the student uses;

(B) Glucagon in an emergency situation to students with diabetes;

(D) Blood glucose monitoring or assist a student with blood glucose monitoring[.]; or

(E) Emergency use of bronchodilators; provided that a school may maintain a supply of bronchodilators to be administered by a school nurse or other authorized employees and agents for actual or perceived asthma episodes pursuant to section 302A- .

(b) The student's parent or guardian shall provide the department with:

(1) Written authorization for the self-administration of medication or the emergency administration of glucagon or auto-injectable epinephrine;

(2) In the case of self‑administration of medication:

(A) Written certification from the student's physician, advanced practice registered nurse, or physician assistant stating that the student with diabetes may perform the student's own blood glucose checks, administer insulin through the student's insulin delivery system, and otherwise attend to the care and management of the student's diabetes during any school-related activity, and that the student may possess on the student's person all necessary supplies and equipment to perform the diabetes monitoring and treatment activities, if applicable; and

(B) Written certification from the student's physician, advanced practice registered nurse, or physician assistant stating that the student:

(i) Has asthma, anaphylaxis, or another potentially life-threatening illness; and

(ii) Is capable of, and has been instructed in, the proper method of self-administration of medication or blood glucose monitoring; and

(3) In the case of administration of insulin or emergency administration of glucagon to a student with diabetes, blood glucose monitoring of a student, or auto-injectable epinephrine to a student with anaphylaxis, written certification from the student's physician, advanced practice registered nurse, or physician assistant stating that the student has medical orders that insulin, glucagon, blood glucose monitoring, or auto-injectable epinephrine may be administered by a volunteer.

(c) The department shall inform the student's parent or guardian in writing that the department and its employees or agents shall not incur any liability as a result of any injury arising from compliance with this section.

(d) The student's parent or guardian shall sign a statement acknowledging that:

(1) The department and its employees or agents shall not incur any liability as a result of any injury arising from compliance with this section; and

(2) The parent or guardian shall indemnify and hold harmless the department and its employees or agents against any claims arising out of compliance with this section.

(e) The permission shall be effective for the school year for which it is granted and shall be renewed for each subsequent school year upon the fulfillment of the requirements in this section.

(f) Notwithstanding any other law to the contrary, a student who is permitted to self-administer medication under this section shall be permitted to carry an inhaler or auto‑injectable epinephrine, or both, at all times if the student does not endanger the student's person or other persons through the misuse of the inhaler; provided that the department, its employees or agents may confiscate a student's medication, inhaler, or auto-injectable epinephrine if the student's self‑administration of the medication exceeds the student's prescribed dosage, or if the student endangers others with the student's medication, inhaler, or auto-injectable epinephrine.

For the purposes of this section, the term "inhaler" includes:

(1) Metered-dose, breath-actuated, and dry powder inhalers; [~~and~~]

(2) Spacers and holding chambers[.]; and

(3) Bronchodilators, including any medication used for the quick relief of asthma symptoms that dilates the airways and is recommended by the National Heart, Lung and Blood Institute's National Asthma Education and Prevention Program Guidelines for the Treatment of Asthma; provided that bronchodilators may include an orally inhaled medication that contains a premeasured single dose of albuterol or albuterol sulfate delivered by a nebulizer (compressor device) or by a metered dose inhaler used to treat respiratory distress, including wheezing, shortness of breath, and difficulty breathing or another dosage of a bronchodilator recommended in the Guidelines for the Treatment of Asthma.

(g) Any employee or agent who volunteers to administer insulin or glucagon in an emergency situation to a student with diabetes or auto-injectable epinephrine to a student with anaphylaxis or who volunteers to administer or assist a student with blood glucose monitoring shall receive instruction in the proper administration of insulin, glucagon, auto-injectable epinephrine, or blood glucose monitoring by a qualified health care professional. A "qualified health care professional" means a licensed physician, physician assistant, advanced practice registered nurse or registered nurse, or certified diabetes educator. The student's parent or guardian shall supply the school with the glucagon kit required to administer the glucagon, any supplies necessary to administer insulin, blood glucose monitoring, or with auto-injectable epinephrine supplies to administer epinephrine. The school shall store the glucagon kit, insulin supplies, blood glucose monitoring supplies, or auto-injectable epinephrine supplies in a secure but accessible location.

(h) Any employee or agent who volunteers to administer a bronchodilator in an emergency situation shall receive instruction in the proper administration of bronchodilators and use of spacers by a qualified health care professional. The training shall include causes of asthma exacerbation, recognition of signs and symptoms of asthma attacks, indications for the administration of bronchodilators, the administration technique, and the need for immediate access to a certified emergency responder. Training shall be provided by a school nurse, certified emergency responder, other health care professional, or appropriate online training.

[~~(h)~~] (i) Any person, school district, or school and its employees and agents, including the prescribing physician and pharmacy filling the prescription, except for a qualified health care professional providing the training required in [~~subsection (g),~~] subsections (g) and (h), who acts in accordance with the requirements of this section shall be immune from any civil or criminal liability arising from these acts, except where the person's conduct would constitute gross negligence, wilful and wanton misconduct, or intentional misconduct."

SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	1448
THIRTY-SECOND LEGISLATURE, 2023
STATE OF HAWAII