H.F. 200 Section 1. NEW SECTION . 135.185 Epinephrine auto-injector 1 supply. 2 1. For purposes of this section, unless the context 3 otherwise requires: 4 a. “Epinephrine auto-injector” means the same as provided 5 in section 280.16. 6 b. “Facility” means a food establishment as defined in 7 section 137F.1, a carnival as defined in section 88A.1, a 8 recreational camp, a youth sports facility, or a sports area. 9 c. “Personnel authorized to administer epinephrine” means 10 an employee of a facility who is trained and authorized to 11 administer an epinephrine auto-injector. 12 d. “Physician” means the same as provided in section 280.16. 13 2. Notwithstanding any other provision of law to the 14 contrary, a physician may prescribe epinephrine auto-injectors 15 in the name of a facility to be maintained for use as provided 16 in this section. 17 3. A facility may obtain a prescription for epinephrine 18 auto-injectors and maintain a supply of such auto-injectors in 19 a secure location at each location where a member of the public 20 may be present for use as provided in this section. A facility 21 that obtains such a prescription shall replace epinephrine 22 auto-injectors in the supply upon use or expiration. Personnel 23 authorized to administer epinephrine may possess and administer 24 epinephrine auto-injectors from the supply as provided in this 25 section. 26 4. Personnel authorized to administer epinephrine may 27 provide or administer an epinephrine auto-injector from the 28 facility’s supply to an individual present at the facility 29 if such personnel reasonably and in good faith believe the 30 individual is having an anaphylactic reaction. 31 5. Any personnel authorized to administer epinephrine 32 who provide, administer, or assist in the administration of 33 an epinephrine auto-injector to an individual present at the 34 facility who such personnel reasonably and in good faith 35 -1- LSB 2138HH (2) 86 je/nh 1/ 8

H.F. 200 believe to be having an anaphylactic reaction; a facility 1 employing the personnel; the owner or operator of the facility; 2 or the prescriber of the epinephrine auto-injector, shall 3 incur no liability, except for gross negligence, as a result 4 of any injury arising from the provision, administration, 5 or assistance in the administration of an epinephrine 6 auto-injector as provided in this section. 7 6. The department of public health, the board of medicine, 8 and the board of pharmacy shall adopt rules pursuant to chapter 9 17A to implement and administer this section, including but 10 not limited to standards and procedures for the prescription, 11 distribution, storage, replacement, and administration of 12 epinephrine auto-injectors, and for training and authorization 13 to be required for personnel authorized to administer 14 epinephrine. 15 Sec. 2. Section 280.16, Code 2015, is amended to read as 16 follows: 17 280.16 Self-administration of asthma or other airway 18 constricting disease medication certain medications . 19 1. Definitions. For purposes of this section : 20 a. “Epinephrine auto-injector” means a medical device for 21 immediate self-administration of a measured dose of epinephrine 22 by a person at risk of anaphylaxis. 23 a. b. “Medication” means a drug that meets the definition 24 provided in section 126.2, subsection 8 , has an individual 25 prescription label, is prescribed by a physician for a 26 student, and pertains to the student’s asthma or other airway 27 constricting disease. 28 b. c. “Physician” means a person licensed under chapter 29 148 , or a physician’s assistant, advanced registered nurse 30 practitioner, or other person licensed or registered to 31 distribute or dispense a prescription drug or device in the 32 course of professional practice in this state in accordance 33 with section 147.107 , or a person licensed by another state 34 in a health field in which, under Iowa law, licensees in this 35 -2- LSB 2138HH (2) 86 je/nh 2/ 8

H.F. 200 state may legally prescribe drugs. 1 c. d. “Self-administration” means a student’s discretionary 2 use of medication prescribed by a physician for the student. 3 2. The board of directors of a school district and the 4 authorities in charge of an accredited nonpublic school shall 5 permit the self-administration of medication by a student 6 with asthma or other airway constricting disease or the use 7 of an epinephrine auto-injector by a student if the following 8 conditions are met: 9 a. The student’s parent or guardian provides to the school 10 written authorization for the self-administration of medication 11 or for the use of an epinephrine auto-injector . 12 b. The student’s parent or guardian provides to the school 13 a written statement from the student’s physician containing the 14 following information: 15 (1) The name and purpose of the medication or epinephrine 16 auto-injector . 17 (2) The prescribed dosage. 18 (3) The times at which or the special circumstances under 19 which the medication or epinephrine auto-injector is to be 20 administered. 21 c. The parent or guardian and the school meet the 22 requirements of subsection 3 . 23 3. The school district or accredited nonpublic school 24 shall notify the parent or guardian of the student, in 25 writing, that the school district or accredited nonpublic 26 school and its employees are to incur no liability, except 27 for gross negligence, as a result of any injury arising from 28 self-administration of medication or use of an epinephrine 29 auto-injector by the student. The parent or guardian of the 30 student shall sign a statement acknowledging that the school 31 district or nonpublic school is to incur no liability, except 32 for gross negligence, as a result of self-administration of 33 medication or use of an epinephrine auto-injector by the 34 student. A school district or accredited nonpublic school 35 -3- LSB 2138HH (2) 86 je/nh 3/ 8

H.F. 200 and its employees acting reasonably and in good faith shall 1 incur no liability for any improper use of medication or an 2 epinephrine auto-injector as defined in this section or for 3 supervising, monitoring, or interfering with a student’s 4 self-administration of medication or use of an epinephrine 5 auto-injector as defined in this section . 6 4. The permission for self-administration of medication 7 or use of an epinephrine auto-injector is effective for the 8 school year for which it is granted and shall be renewed each 9 subsequent school year upon fulfillment of the requirements 10 of this section . However, the parent or guardian shall 11 immediately notify the school of any changes in the conditions 12 listed under subsection 2 . 13 5. Provided that the requirements of this section are 14 fulfilled, a student with asthma or other airway constricting 15 disease may possess and use the student’s medication and a 16 student with a written statement from a physician on file 17 pursuant to subsection 2, paragraph “a” , may use an epinephrine 18 auto-injector while in school, at school-sponsored activities, 19 under the supervision of school personnel, and before or after 20 normal school activities, such as while in before-school or 21 after-school care on school-operated property. If the student 22 misuses this privilege, the privilege may be withdrawn. A 23 school district or nonpublic school shall notify a student’s 24 parent or guardian before withdrawing the privilege to use an 25 epinephrine auto-injector. 26 6. Information provided to the school under subsection 2 27 shall be kept on file in the office of the school nurse or, in 28 the absence of a school nurse, the school’s administrator. 29 7. The Iowa braille and sight saving school, the state 30 school for the deaf, and the institutions under the control of 31 the department of human services as provided in section 218.1 32 are exempt from the provisions of this section . 33 Sec. 3. NEW SECTION . 280.16A Epinephrine auto-injector 34 supply. 35 -4- LSB 2138HH (2) 86 je/nh 4/ 8

H.F. 200 1. For purposes of this section, unless the context 1 otherwise requires: 2 a. “Epinephrine auto-injector” means the same as provided 3 in section 280.16. 4 b. “Personnel authorized to administer epinephrine” 5 means a school nurse or other employee of a school district 6 or accredited nonpublic school trained and authorized to 7 administer an epinephrine auto-injector. 8 c. “Physician” means the same as provided in section 280.16. 9 2. Notwithstanding any other provision of law to the 10 contrary, a physician may prescribe epinephrine auto-injectors 11 in the name of a school district or accredited nonpublic school 12 to be maintained for use as provided in this section. 13 3. The board of directors in charge of each school district 14 and the authorities in charge of each accredited nonpublic 15 school may obtain a prescription for epinephrine auto-injectors 16 and maintain a supply of such auto-injectors in a secure 17 location at each school for use as provided in this section. 18 The board and the authorities shall replace epinephrine 19 auto-injectors in the supply upon use or expiration. Personnel 20 authorized to administer epinephrine may possess and administer 21 epinephrine auto-injectors from the supply as provided in this 22 section. 23 4. Personnel authorized to administer epinephrine may 24 provide or administer an epinephrine auto-injector from the 25 school’s supply to a student if such personnel reasonably and 26 in good faith believe the student is having an anaphylactic 27 reaction. 28 5. Any personnel authorized to administer epinephrine 29 who provide, administer, or assist in the administration 30 of an epinephrine auto-injector to a student who such 31 personnel reasonably and in good faith believe to be having 32 an anaphylactic reaction; a school district or accredited 33 nonpublic school employing the personnel; the board of 34 directors in charge of the school district or authorities in 35 -5- LSB 2138HH (2) 86 je/nh 5/ 8

H.F. 200 charge of the accredited nonpublic school; or the prescriber 1 of the epinephrine auto-injector, shall incur no liability, 2 except for gross negligence, as a result of any injury arising 3 from the provision, administration, or assistance in the 4 administration of an epinephrine auto-injector as provided in 5 this section. 6 6. The department of education, the board of medicine, and 7 the board of pharmacy shall adopt rules pursuant to chapter 8 17A to implement and administer this section, including but 9 not limited to standards and procedures for the prescription, 10 distribution, storage, replacement, and administration of 11 epinephrine auto-injectors, and for training and authorization 12 to be required for personnel authorized to administer 13 epinephrine. 14 EXPLANATION 15 The inclusion of this explanation does not constitute agreement with 16 the explanation’s substance by the members of the general assembly. 17 This bill permits the board of directors in charge of 18 each school district and the authorities in charge of an 19 accredited nonpublic school to maintain in a secure location 20 at each school a supply of epinephrine auto-injectors for 21 use as provided in the bill. The bill requires the board 22 and authorities to replace epinephrine auto-injectors in the 23 supply upon use or expiration. The bill permits the board 24 and authorities to obtain a prescription for epinephrine 25 auto-injectors for use as provided in the bill. The bill 26 permits personnel authorized to administer epinephrine to 27 possess and administer epinephrine auto-injectors from the 28 supply as provided in the bill. The bill permits a physician 29 to prescribe epinephrine auto-injectors in the name of a school 30 district or accredited nonpublic school to be maintained 31 for use as provided in the bill, notwithstanding any other 32 provision of law to the contrary. 33 The bill permits personnel authorized to administer 34 epinephrine to provide or administer an epinephrine 35 -6- LSB 2138HH (2) 86 je/nh 6/ 8

H.F. 200 auto-injector from a school’s supply to a student if such 1 personnel reasonably and in good faith believe the student is 2 having an anaphylactic reaction. 3 The bill provides immunity from legal liability, except for 4 gross negligence, to any personnel authorized to administer 5 epinephrine who provide, administer, or assist in the 6 administration of an epinephrine auto-injector to a student 7 who such personnel reasonably and in good faith believe to 8 be having an anaphylactic reaction; a school district or 9 accredited nonpublic school employing the personnel; the board 10 of directors in charge of the school district or authorities in 11 charge of the accredited nonpublic school; or the prescriber of 12 the epinephrine auto-injector, for any injury arising from the 13 provision, administration, or assistance in the administration 14 of an epinephrine auto-injector as provided in the bill. 15 The bill defines “epinephrine auto-injector” as a medical 16 device for immediate self-administration of a measured dose 17 of epinephrine by a person at risk of anaphylaxis. The bill 18 defines “personnel authorized to administer epinephrine” as 19 an employee who is trained and authorized to administer an 20 epinephrine auto-injector. 21 The bill permits certain facilities to maintain a supply of 22 epinephrine auto-injectors in the same fashion at locations 23 where members of the public may be present, with the same 24 duties, powers, and immunities relating to maintaining a 25 supply of epinephrine auto-injectors and administering the 26 auto-injectors applying if the facility chooses to do so. The 27 bill defines “facility” as a food establishment as defined in 28 Code section 137F.1, a carnival as defined in Code section 29 88A.1, a recreational camp, a youth sports facility, or a 30 sports area. 31 The bill requires the department of education, the 32 department of public health, the board of medicine, and the 33 board of pharmacy to adopt rules to implement and administer 34 the bill, including but not limited to standards and procedures 35 -7- LSB 2138HH (2) 86 je/nh 7/ 8

H.F. 200 for the prescription, distribution, storage, replacement, and 1 administration of epinephrine auto-injectors, and for training 2 and authorization to be required for personnel authorized to 3 administer epinephrine auto-injectors. 4 The bill also adds epinephrine auto-injectors to Code 5 section 280.16, which permits self-administration of medication 6 in public and nonpublic schools by students with asthma. 7 The bill requires school districts and nonpublic schools 8 to allow the use of an epinephrine auto-injector by a student 9 with a written statement from a physician on file if the school 10 receives written authorization and certain medical information 11 from the student’s parent or guardian. 12 The bill permits a student with a written statement 13 from a physician on file to possess and use an epinephrine 14 auto-injector while in school, at school-sponsored activities, 15 under the supervision of school personnel, and before or after 16 normal school activities, such as while in before-school or 17 after-school care on school-operated property. The bill 18 requires a school district or nonpublic school to notify a 19 student’s parent or guardian before withdrawing the privilege 20 to use an epinephrine auto-injector. 21 The bill adds epinephrine auto-injectors to the provisions 22 of Code section 280.16 granting immunity from legal liability 23 to school employees, except for gross negligence, for injuries 24 resulting from the self-administration of medication. Code 25 section 280.16 requires a student’s parent or guardian to 26 receive notice of such immunity. 27 -8- LSB 2138HH (2) 86 je/nh 8/ 8