Hawaii-2014-SB2954-Introduced

SECTION 1. Chapter 302A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§302A‑ Life-threatening allergy medication in schools; guidelines; stock supply of epinephrine auto-injectors; emergency administration. (a) An authorized health care provider may prescribe epinephrine auto-injectors in the name of a school for use in accordance with this section. Pharmacists and authorized health care providers may dispense epinephrine auto-injectors pursuant to a prescription issued in the name of a school. A school may maintain a stock supply of epinephrine auto-injectors for use in accordance with this section.

(b) School nurses and designated school personnel may, upon authorization by the principal, use epinephrine auto-injectors prescribed pursuant to subsection (a) to:

(1) Provide an epinephrine auto-injector to a student for self-administration in accordance with a prescription specific to the student on file with the school;

(2) Administer an epinephrine auto-injector to a student in accordance with a prescription specific to the student on file with the school; and

(3) Administer an epinephrine auto-injector to any student or other individual, on school premises, at school-sponsored events, or at any other time the student or individual is subject to the school's jurisdiction or supervision; provided that the school nurse or designated school personnel believes in good faith the student or other individual is experiencing anaphylaxis in accordance with a standing protocol from an authorized health care provider, regardless of whether the student or other individual has a prescription for an epinephrine auto-injector or has previously been diagnosed with an allergy.

(c) A school may enter into arrangements with manufacturers of epinephrine auto-injectors or third-party suppliers of epinephrine auto-injectors to obtain epinephrine auto-injectors at fair-market, free, or reduced prices.

(d) Designated school personnel shall complete an anaphylaxis training program prior to providing or administering an epinephrine auto-injector made available by a school and at least every two years following completion of the initial anaphylaxis training program. The training shall be conducted by a nationally recognized organization experienced in training laypersons in emergency health treatment or an entity or individual approved by the department of health. Training may be conducted online or in person and, at a minimum, shall cover:

(1) Techniques on how to recognize symptoms of severe allergic reactions, including anaphylaxis;

(2) Standards and procedures for the storage and administration of an epinephrine auto-injector; and

(3) Emergency follow-up procedures.

The entity that conducts the training shall issue a certificate, on a form developed or approved by the department of health, to each person who successfully completes the anaphylaxis training program.

(e) Not later than December 31, 2015, the department, in consultation with the department of health, shall develop and make available to all schools guidelines for the management of students with life-threatening food allergies. The guidelines shall include:

(1) Education and training for school personnel on the management of students with life-threatening allergies, including training related to the administration of an epinephrine auto-injector;

(2) Procedures for responding to life-threatening allergic reactions;

(3) A process for the development of individualized health care and allergy action plans for every student with a known life-threatening allergy; and

(4) Protocols to prevent exposure to allergens.

(f) Not later than , the board shall:

(1) Implement a plan based on the guidelines developed pursuant to subsection (e) for the management of students with life-threatening allergies enrolled in the schools under its jurisdiction; and

(2) Make the plan available on the board's web site or the web site of each school under the board's jurisdiction, or if the web sites do not exist, make the plan publicly available through other practicable means as determined by the board.

(g) A school that possesses and makes available a stock supply of epinephrine auto-injectors pursuant to this section shall submit to the department, on a form developed by the department, a report of each incident that involves a severe allergic reaction or the administration of an epinephrine auto-injector. The department shall annually publish a report that summarizes and analyzes all reports submitted to it pursuant to this subsection.

(h) The following persons or entities shall not be civilly liable for damages arising from the administration of, self-administration of, or failure to administer an epinephrine auto-injector or any other act or omission taken pursuant to this section, regardless of whether authorization was provided by the student's parent or guardian or by the student's health care provider:

(1) A school that possesses and makes available epinephrine auto-injectors and its principal, school nurses, employees, agents, and volunteers;

(2) An authorized health care provider that prescribes epinephrine auto-injectors to a school; and

(3) An individual or entity that conducts the training described in subsection (d);

provided that this subsection does not apply to gross negligence or wanton acts or omissions. This section does not eliminate, limit, or reduce any other immunity or defense that may be available under state law, including that provided under section 663-1.5.

(i) The administration of an epinephrine auto-injector in accordance with this section shall not constitute the practice of medicine.

(j) As used in this section:

"Administer" means the direct application of an epinephrine auto-injector to the body of an individual.

"Authorized health care provider" means an individual licensed by the State or authorized by the laws of the State to prescribe prescription drugs within the scope of the person's practice.

"Designated school personnel" means an employee, agent, or volunteer of a school principal who has completed the training required under subsection (d) and who has been designated by the school principal to provide or administer an epinephrine auto-injector.

"Epinephrine auto-injector" means a single-use device used for the automatic injection of a premeasured dose of epinephrine into the human body.

"Provide" means the supply of one or more epinephrine auto-injectors to an individual.

"School" shall have the same meaning as the term "public schools" in section 302A-101, excluding charter schools governed by chapter 302D.

"Self-administration" means a student or other person's discretionary use of an epinephrine auto-injector, whether provided by the student or by a school nurse or designated school personnel pursuant to this section."

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§321- Life-threatening allergy medication; stock supply of epinephrine auto-injectors; emergency administration. (a) An authorized health care provider may prescribe epinephrine auto-injectors in the name of an authorized entity for use in accordance with this section. Pharmacists and authorized health care providers may dispense epinephrine auto-injectors pursuant to a prescription issued in the name of an authorized entity.

(b) An authorized entity may acquire and stock a supply of epinephrine auto-injectors pursuant to a prescription issued in accordance with this section. Epinephrine auto-injectors shall be stored in a location readily accessible in an emergency and in accordance with the epinephrine auto-injector's instructions for use; provided that any additional requirements may be established by the department of health. An authorized entity shall designate employees or agents who have completed the training required by subsection (d) to be responsible for the storage, maintenance, and general oversight of epinephrine auto-injectors acquired by the authorized entity.

(c) An employee or agent of an authorized entity, or other individual, who has completed the training required by subsection (d) may, on the premises of or in connection with the authorized entity, use epinephrine auto-injectors prescribed pursuant to subsection (a) to:

(1) Provide an epinephrine auto-injector to any individual the employee, agent, or other individual believes in good faith is experiencing anaphylaxis for immediate self-administration, regardless of whether the individual has a prescription for an epinephrine auto-injector or has previously been diagnosed with an allergy; and

(2) Administer an epinephrine auto-injector to any individual the employee, agent, or other individual believes in good faith is experiencing anaphylaxis, regardless of whether the individual has a prescription for an epinephrine auto-injector or has previously been diagnosed with an allergy.

(d) An employee, agent, or other individual described in subsection (c) shall complete an anaphylaxis training program prior to providing or administering an epinephrine auto-injector made available by an authorized entity and at least every two years following completion of the initial anaphylaxis training program. The training shall be conducted by a nationally recognized organization experienced in training laypersons in emergency health treatment or an entity or individual approved by the department of health. Training may be conducted online or in person and, at a minimum, shall cover:

(1) Techniques on how to recognize symptoms of severe allergic reactions, including anaphylaxis;

(2) Standards and procedures for the storage and administration of an epinephrine auto-injector; and

(3) Emergency follow-up procedures.

(e) The following individuals or entities shall not be liable for any civil damages arising from the administration of, self-administration of, or failure to administer an epinephrine auto-injector or any other act or omission taken pursuant to this section:

(1) An authorized entity that possesses and makes available epinephrine auto-injectors, and its employees, agents, and other trained individuals;

(2) A person who uses an epinephrine auto-injector made available pursuant to subsection (h);

(3) An authorized health care provider that prescribes epinephrine auto-injectors to an authorized entity; and

(4) An individual or entity that conducts the training described in subsection (d);

provided that the immunity under this subsection does not apply to gross negligence or wanton acts or omissions.

(f) The administration of an epinephrine auto-injector in accordance with this section shall not constitute the practice of medicine. This section shall not eliminate, limit, or reduce any other immunity or defense that may be available under state law, including that provided under section 663-1.5. An 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 by its employees or agents outside of this State if the entity or its employee or agent:

(1) Would not have been liable for such injuries or related damages had the provision or administration occurred within this State; or

(2) Is not liable for such injuries or related damages under the law of the state in which the provision or administration occurred.

(g) An authorized entity that possesses and makes available epinephrine auto-injectors pursuant to this section shall submit to the department of health, on a form developed by the department, a report of each incident on the authorized entity's premises that involves the administration of an epinephrine auto-injector. The department shall annually publish a report that summarizes and analyzes all reports submitted to it pursuant to this subsection.

(h) An authorized entity that acquires a stock supply of epinephrine auto-injectors pursuant to a prescription issued in accordance with this section may make epinephrine auto-injectors available to individuals other than those trained individuals described in subsection (c), and the individuals may administer epinephrine auto-injector to any individual believed in good faith to be experiencing anaphylaxis; provided that the epinephrine auto-injectors are stored in a locked and secure container, and are made available only upon remote authorization by an authorized health care provider after consultation with the authorized health care provider by audio, televideo, or other similar means of electronic communication. Consultation with an authorized health care provider for this purpose shall not be considered the practice of telemedicine or otherwise be construed as violating any law or rule regulating the authorized health care provider's professional practice.

(i) As used in this section:

"Administer" means the direct application of an epinephrine auto-injector to the body of an individual.

"Authorized entity" means any entity or organization at or in connection with which allergens capable of causing anaphylaxis may be present, including restaurants, recreation camps, youth sports leagues, amusement parks, and sports arenas; provided that a public school, as defined in section 302A-101, is an authorized entity for purposes of subsection (h) only.

"Authorized health care provider" means an individual licensed by the State or authorized by the laws of the State to prescribe prescription drugs within the scope of the person's practice.

"Epinephrine auto-injector" means a single-use device used for the automatic injection of a premeasured dose of epinephrine into the human body.

"Provide" means to supply one or more epinephrine auto-injectors to an individual.

"Self-administration" means the discretionary use of an epinephrine auto-injector."

SECTION 3. New statutory material is underscored.

SECTION 4. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2954
TWENTY-SEVENTH LEGISLATURE, 2014
STATE OF HAWAII