S.F. 462 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. “Licensed health care professional” means the same as 10 provided in section 280.16. 11 d. “Personnel authorized to administer epinephrine” means 12 an employee of a facility who is trained and authorized to 13 administer an epinephrine auto-injector. 14 e. “Physician” means the same as provided in section 280.16. 15 2. Notwithstanding any other provision of law to the 16 contrary, a licensed health care professional may prescribe 17 epinephrine auto-injectors in the name of a facility to be 18 maintained for use as provided in this section. 19 3. A facility may obtain a prescription for epinephrine 20 auto-injectors and maintain a supply of such auto-injectors in 21 a secure location at each location where a member of the public 22 may be present for use as provided in this section. A facility 23 that obtains such a prescription shall replace epinephrine 24 auto-injectors in the supply upon use or expiration. Personnel 25 authorized to administer epinephrine may possess and administer 26 epinephrine auto-injectors from the supply as provided in this 27 section. 28 4. Personnel authorized to administer epinephrine may 29 provide or administer an epinephrine auto-injector from the 30 facility’s supply to an individual present at the facility 31 if such personnel reasonably and in good faith believe the 32 individual is having an anaphylactic reaction. 33 5. The following persons, provided they have acted 34 reasonably and in good faith, shall not be liable for 35 -1- LSB 2138SV (4) 86 je/nh 1/ 9

S.F. 462 any injury arising from the provision, administration, 1 or assistance in the administration of an epinephrine 2 auto-injector as provided in this section: 3 a. Any personnel authorized to administer epinephrine 4 who provide, administer, or assist in the administration 5 of an epinephrine auto-injector to an individual present 6 at the facility who such personnel believe to be having an 7 anaphylactic reaction. 8 b. The owner or operator of the facility. 9 c. The prescriber of the epinephrine auto-injector. 10 6. The department of public health, the board of medicine, 11 the board of nursing, and the board of pharmacy shall adopt 12 rules pursuant to chapter 17A to implement and administer this 13 section, including but not limited to standards and procedures 14 for the prescription, distribution, storage, replacement, and 15 administration of epinephrine auto-injectors, and for training 16 and authorization to be required for personnel authorized to 17 administer epinephrine. 18 Sec. 2. Section 280.16, Code 2015, is amended to read as 19 follows: 20 280.16 Self-administration of asthma or other airway 21 constricting disease medication or epinephrine auto-injectors . 22 1. Definitions. For purposes of this section : 23 a. “Epinephrine auto-injector” means a medical device for 24 immediate self-administration or administration by another 25 trained individual of a measured dose of epinephrine to a 26 person at risk of anaphylaxis. 27 b. “ Licensed health care professional” means a person 28 licensed under chapter 148 to practice medicine and surgery or 29 osteopathic medicine and surgery, an advanced registered nurse 30 practitioner licensed under chapter 152 or 152E and registered 31 with the board of nursing, or a physician assistant licensed to 32 practice under the supervision of a physician as authorized in 33 chapters 147 and 148C. 34 a. c. “Medication” means a drug that meets the definition 35 -2- LSB 2138SV (4) 86 je/nh 2/ 9

S.F. 462 provided in section 126.2, subsection 8 , has an individual 1 prescription label, is prescribed by a physician licensed 2 health care professional for a student, and pertains to the 3 student’s asthma or other airway constricting disease or risk 4 of anaphylaxis . 5 b. “Physician” means a person licensed under chapter 6 148 , or a physician’s assistant, advanced registered nurse 7 practitioner, or other person licensed or registered to 8 distribute or dispense a prescription drug or device in the 9 course of professional practice in this state in accordance 10 with section 147.107 , or a person licensed by another state 11 in a health field in which, under Iowa law, licensees in this 12 state may legally prescribe drugs. 13 c. d. “Self-administration” means a student’s discretionary 14 use of medication prescribed by a physician licensed health 15 care professional for the student. 16 2. The board of directors of a school district and the 17 authorities in charge of an accredited nonpublic school shall 18 permit the self-administration of medication by a student 19 with asthma or other airway constricting disease or the use 20 of an epinephrine auto-injector by a student with a risk of 21 anaphylaxis if the following conditions are met: 22 a. The student’s parent or guardian provides to the school 23 written authorization for the self-administration of medication 24 or for the use of an epinephrine auto-injector . 25 b. The student’s parent or guardian provides to the school 26 a written statement from the student’s physician containing the 27 following information: 28 (1) The name and purpose of the medication or epinephrine 29 auto-injector . 30 (2) The prescribed dosage. 31 (3) The times at which or the special circumstances under 32 which the medication or epinephrine auto-injector is to be 33 administered. 34 c. The parent or guardian and the school meet the 35 -3- LSB 2138SV (4) 86 je/nh 3/ 9

S.F. 462 requirements of subsection 3 . 1 3. The school district or accredited nonpublic school 2 shall notify the parent or guardian of the student, in 3 writing, that the school district or accredited nonpublic 4 school and its employees are to incur no liability, except 5 for gross negligence, as a result of any injury arising from 6 self-administration of medication or use of an epinephrine 7 auto-injector by the student. The parent or guardian of the 8 student shall sign a statement acknowledging that the school 9 district or nonpublic school is to incur no liability, except 10 for gross negligence, as a result of self-administration of 11 medication or use of an epinephrine auto-injector by the 12 student. A school district or accredited nonpublic school 13 and its employees acting reasonably and in good faith shall 14 incur no liability for any improper use of medication or an 15 epinephrine auto-injector as defined in this section or for 16 supervising, monitoring, or interfering with a student’s 17 self-administration of medication or use of an epinephrine 18 auto-injector as defined in this section . 19 4. The permission for self-administration of medication 20 or use of an epinephrine auto-injector is effective for the 21 school year for which it is granted and shall be renewed each 22 subsequent school year upon fulfillment of the requirements 23 of this section . However, the parent or guardian shall 24 immediately notify the school of any changes in the conditions 25 listed under subsection 2 . 26 5. Provided that the requirements of this section are 27 fulfilled, a student with asthma or other airway constricting 28 disease may possess and use the student’s medication and a 29 student with a written statement from a licensed health care 30 professional on file pursuant to subsection 2, paragraph 31 “a” , may use an epinephrine auto-injector while in school, 32 at school-sponsored activities, under the supervision 33 of school personnel, and before or after normal school 34 activities, such as while in before-school or after-school 35 -4- LSB 2138SV (4) 86 je/nh 4/ 9

S.F. 462 care on school-operated property. If the student misuses 1 this privilege, the privilege may be withdrawn. A school 2 district or nonpublic school shall notify a student’s parent or 3 guardian before withdrawing the privilege to use an epinephrine 4 auto-injector. 5 6. Information provided to the school under subsection 2 6 shall be kept on file in the office of the school nurse or, in 7 the absence of a school nurse, the school’s administrator. 8 7. The Iowa braille and sight saving school, the state 9 school for the deaf, and the institutions under the control of 10 the department of human services as provided in section 218.1 11 are exempt from the provisions of this section . 12 Sec. 3. NEW SECTION . 280.16A Epinephrine auto-injector 13 supply. 14 1. For purposes of this section, unless the context 15 otherwise requires: 16 a. “Epinephrine auto-injector” means the same as provided 17 in section 280.16. 18 b. “Licensed health care professional” means the same as 19 provided in section 280.16. 20 c. “Personnel authorized to administer epinephrine” 21 means a school nurse or other employee of a school district 22 or accredited nonpublic school trained and authorized to 23 administer an epinephrine auto-injector. 24 2. Notwithstanding any other provision of law to the 25 contrary, a licensed health care provider may prescribe 26 epinephrine auto-injectors in the name of a school district 27 or accredited nonpublic school to be maintained for use as 28 provided in this section. 29 3. The board of directors in charge of each school district 30 and the authorities in charge of each accredited nonpublic 31 school may obtain a prescription for epinephrine auto-injectors 32 and maintain a supply of such auto-injectors in a secure 33 location at each school for use as provided in this section. 34 The board and the authorities shall replace epinephrine 35 -5- LSB 2138SV (4) 86 je/nh 5/ 9

S.F. 462 auto-injectors in the supply upon use or expiration. Personnel 1 authorized to administer epinephrine may possess and administer 2 epinephrine auto-injectors from the supply as provided in this 3 section. 4 4. Personnel authorized to administer epinephrine may 5 provide or administer an epinephrine auto-injector from the 6 school’s supply to a student or other individual if such 7 personnel reasonably and in good faith believe the student or 8 other individual is having an anaphylactic reaction. 9 5. The following persons, provided they have acted 10 reasonably and in good faith, shall not be liable for 11 any injury arising from the provision, administration, 12 or assistance in the administration of an epinephrine 13 auto-injector as provided in this section: 14 a. Any personnel authorized to administer epinephrine who 15 provide, administer, or assist in the administration of an 16 epinephrine auto-injector to a student or other individual 17 present at the school who such personnel believe to be having 18 an anaphylactic reaction. 19 b. A school district or accredited nonpublic school 20 employing the personnel. 21 c. The board of directors in charge of the school district 22 or authorities in charge of the accredited nonpublic school. 23 d. The prescriber of the epinephrine auto-injector. 24 6. The department of education, the board of medicine, 25 the board of nursing, and the board of pharmacy shall, in 26 consultation with an organization representing school nurses, 27 adopt rules pursuant to chapter 17A to implement and administer 28 this section, including but not limited to standards and 29 procedures for the prescription, distribution, storage, 30 replacement, and administration of epinephrine auto-injectors, 31 and for training and authorization to be required for personnel 32 authorized to administer epinephrine. 33 EXPLANATION 34 The inclusion of this explanation does not constitute agreement with 35 -6- LSB 2138SV (4) 86 je/nh 6/ 9

S.F. 462 the explanation’s substance by the members of the general assembly. 1 This bill permits the board of directors in charge of 2 each school district and the authorities in charge of an 3 accredited nonpublic school to maintain in a secure location 4 at each school a supply of epinephrine auto-injectors for 5 use as provided in the bill. The bill requires the board 6 and authorities to replace epinephrine auto-injectors in the 7 supply upon use or expiration. The bill permits the board 8 and authorities to obtain a prescription for epinephrine 9 auto-injectors for use as provided in the bill. The bill 10 permits personnel authorized to administer epinephrine 11 to possess and administer epinephrine auto-injectors from 12 the supply as provided in the bill. The bill permits a 13 licensed health care professional to prescribe epinephrine 14 auto-injectors in the name of a school district or accredited 15 nonpublic school to be maintained for use as provided in 16 the bill, notwithstanding any other provision of law to the 17 contrary. 18 The bill permits personnel authorized to administer 19 epinephrine to provide or administer an epinephrine 20 auto-injector from a school’s supply to a student or 21 other individual if such personnel reasonably and in good 22 faith believe the student or other individual is having an 23 anaphylactic reaction. 24 The bill provides immunity from legal liability to any 25 personnel authorized to administer epinephrine who provide, 26 administer, or assist in the administration of an epinephrine 27 auto-injector to a student or other individual who such 28 personnel reasonably and in good faith believe to be having 29 an anaphylactic reaction; a school district or accredited 30 nonpublic school employing the personnel; the board of 31 directors in charge of the school district or authorities in 32 charge of the accredited nonpublic school; or the prescriber of 33 the epinephrine auto-injector, for any injury arising from the 34 provision, administration, or assistance in the administration 35 -7- LSB 2138SV (4) 86 je/nh 7/ 9

S.F. 462 of an epinephrine auto-injector as provided in the bill, 1 provided such persons acted reasonably and in good faith. 2 The bill defines “epinephrine auto-injector” as a medical 3 device for immediate self-administration or administration by 4 another trained individual of a measured dose of epinephrine to 5 a person at risk of anaphylaxis. The bill defines “personnel 6 authorized to administer epinephrine” as an employee who 7 is trained and authorized to administer an epinephrine 8 auto-injector. The bill defines “licensed health care 9 professional” as a person licensed under Code chapter 148 to 10 practice medicine and surgery or osteopathic medicine and 11 surgery, an advanced registered nurse practitioner licensed 12 under Code chapter 152 or 152E and registered with the board of 13 nursing, or a physician assistant licensed to practice under 14 the supervision of a physician as authorized in Code chapters 15 147 and 148C. 16 The bill permits certain facilities to maintain a supply of 17 epinephrine auto-injectors in the same fashion at locations 18 where members of the public may be present, with the same 19 duties, powers, and immunities relating to maintaining a 20 supply of epinephrine auto-injectors and administering the 21 auto-injectors applying if the facility chooses to do so. The 22 bill defines “facility” as a food establishment as defined in 23 Code section 137F.1, a carnival as defined in Code section 24 88A.1, a recreational camp, a youth sports facility, or a 25 sports area. 26 The bill requires the department of education, the 27 department of public health, the board of medicine, the 28 board of nursing, and the board of pharmacy to adopt rules to 29 implement and administer the bill, including but not limited to 30 standards and procedures for the prescription, distribution, 31 storage, replacement, and administration of epinephrine 32 auto-injectors, and for training and authorization to be 33 required for personnel authorized to administer epinephrine 34 auto-injectors. 35 -8- LSB 2138SV (4) 86 je/nh 8/ 9

S.F. 462 The bill also adds epinephrine auto-injectors to Code 1 section 280.16, which permits self-administration of medication 2 in public and nonpublic schools by students with asthma. 3 The bill requires school districts and nonpublic schools to 4 allow the use of an epinephrine auto-injector by a student with 5 a risk of anaphylaxis with a written statement from a licensed 6 health care professional on file if the school receives 7 written authorization and certain medical information from the 8 student’s parent or guardian. 9 The bill permits a student with a written statement from a 10 licensed health care professional on file to possess and use an 11 epinephrine auto-injector while in school, at school-sponsored 12 activities, under the supervision of school personnel, and 13 before or after normal school activities, such as while in 14 before-school or after-school care on school-operated property. 15 The bill requires a school district or nonpublic school to 16 notify a student’s parent or guardian before withdrawing the 17 privilege to use an epinephrine auto-injector. 18 The bill adds epinephrine auto-injectors to the provisions 19 of Code section 280.16 granting immunity from legal liability 20 to school employees, except for gross negligence, for injuries 21 resulting from the self-administration of medication. Code 22 section 280.16 requires a student’s parent or guardian to 23 receive notice of such immunity. 24 -9- LSB 2138SV (4) 86 je/nh 9/ 9