SB 194-FN - AS AMENDED BY THE SENATE
03/05/2015 0448s
2015 SESSION
15-0507
04/09
SENATE BILL 194-FN
AN ACT relative to epinephrine administration policies in postsecondary educational institutions.
SPONSORS: Sen. Stiles, Dist 24; Sen. Kelly, Dist 10; Sen. Carson, Dist 14; Sen. Fuller Clark, Dist 21; Sen. Reagan, Dist 17; Sen. Watters, Dist 4; Sen. Avard, Dist 12; Rep. Sherman, Rock 24; Rep. Martel, Hills 44; Rep. Shaw, Hills 16; Rep. Gargasz, Hills 27
This bill permits postsecondary educational institutions to establish guidelines for the emergency administration of epinephrine by designated trainees, establishes requirements for the storage of epinephrine on campus, and limits civil liability for certain individuals who administer an emergency injection of epinephrine.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/05/2015 0448s
15-0507
04/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Fifteen
AN ACT relative to epinephrine administration policies in postsecondary educational institutions.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Chapter; Epinephrine Administration in Postsecondary Educational Institutions. Amend RSA by inserting after chapter 200-M the following new chapter:
CHAPTER 200-N
EPINEPHRINE ADMINISTRATION IN POSTSECONDARY
200-N:1 Definitions. In this chapter:
I. “Anaphylaxis” means a rapidly progressing, life-threatening allergic reaction that can occur following exposure to certain allergens, most commonly, but not limited to, foods, insect stings, medications, and latex. Signs and symptoms of anaphylaxis include, but are not limited to, difficulty breathing, coughing, throat clearing, altered heart rhythms, hives, redness or blotches on the skin, nausea and vomiting, low blood pressure, shock, and loss of consciousness. Failure to treat these symptoms promptly, with epinephrine, may result in serious consequences up to and including death.
II. “Licensed campus medical professional” means any of the following individuals who are employed by or have contracted with a postsecondary educational institution and are designated by the postsecondary educational institution to serve in such a capacity:
(a) A physician licensed under RSA 329.
(b) A physician assistant licensed under RSA 328-D.
(c) An advanced practice registered nurse or registered nurse who is licensed under RSA 326-B:18.
III. “Member of the campus community” means an individual who is a student, faculty member, or staff member of a postsecondary educational institution.
IV. “Trained designee” means a member of the campus community trained by a licensed campus medical professional in the emergency administration of auto-injectable epinephrine.
200-N:2 Emergency Administration of Epinephrine; Policies and Guidelines.
I. A postsecondary educational institution accredited to operate in this state may develop a policy in accordance with this chapter and guidelines issued under RSA 200-N:4 for the emergency administration of auto-injectable epinephrine to a member of the campus community for anaphylaxis when a licensed campus medical professional is not available.
II. Such policy shall include:
(a) Permission for a trained designee to do the following:
(1) Administer auto-injectable epinephrine to a member of the campus community for anaphylaxis when a licensed campus medical professional is unavailable.
(2) When responsible for the safety of at least one member of the campus community, carry in a secure but accessible location a supply of auto-injectable epinephrine that is prescribed under a standing protocol from a health care provider who is licensed in New Hampshire and whose scope of practice includes the prescribing of medication.
(b) Provisions that a licensed campus medical professional has responsibility for training designees in the following:
(1) The administration of auto-injectable epinephrine.
(2) Identification of an anaphylactic reaction and indications for when to use epinephrine.
III. Each postsecondary educational institution that develops a policy under this chapter shall designate a licensed campus medical professional.
IV. A licensed campus medical professional may:
(a) Establish and administer a standardized training protocol for the emergency administration of epinephrine by trained designees.
(b) Ensure that trained designees have satisfactorily completed the training protocol.
(c) Obtain a supply of auto-injectable epinephrine under a standing protocol from a physician licensed under RSA 329.
(d) Control distribution to trained designees of auto-injectable epinephrine.
200-N:3 Requirements for Trained Designees. An individual shall comply with the following requirements in order to act as a trained designee:
I. Be at least 18 years of age.
II. Have or reasonably expect to have, responsibility for at least one other member of the campus community as a result of the individual’s employment.
III. Have satisfactorily completed the standardized training protocol established and administered by a licensed campus medical professional in accordance with guidelines developed under RSA 200-N:4.
200-N:4 Department of Health and Human Services Guidelines. The commissioner of the department of health and human services shall establish guidelines for the development of a policy by an institution of higher education for the emergency administration of epinephrine to a member of the campus community for anaphylaxis when a licensed campus medical professional is not available. The guidelines shall address issues including, but not limited to, the responsibilities of the institution of higher education, the licensed campus medical professional, and the trained designee for the emergency administration of epinephrine. The secretary shall disseminate the guidelines to the president of each institution of higher education.
200-N:5 Storage of Epinephrine.
I. A postsecondary educational institution may fill a prescription for auto-injectable epinephrine and store the auto-injectable epinephrine on the campus if a licensed health care provider whose scope of practice includes the prescribing of medication writes the prescription for auto-injectable epinephrine for the postsecondary educational institution.
II. The postsecondary educational institution shall store the auto-injectable epinephrine in an unlocked safe location in which only postsecondary educational institution personnel have access.
III. A health care provider who is licensed in this state and whose scope of practice includes the prescribing of medication may write a prescription, drug order, or protocol for auto-injectable epinephrine for the postsecondary educational institution.
IV. A pharmacist licensed under RSA 318 may dispense a valid prescription, drug order, or protocol for auto-injectable epinephrine issued in the name of a postsecondary educational institution.
200-N:6 Immunity From Civil Liability.
I. A licensed campus medical professional who acts in accordance with this chapter shall not be liable for civil damages for any act or omission committed in accordance with this chapter unless the act or omission constitutes gross negligence or willful misconduct.
II. A trained designee who administers auto-injectable epinephrine in accordance with this chapter shall not be liable for civil damages resulting from the administration of auto-injectable epinephrine under this chapter unless the act or omission constitutes gross negligence or willful misconduct.
III. A licensed health care provider who writes a prescription, drug order, or protocol under this chapter is not liable for civil damages resulting from the administration of auto-injectable epinephrine under this chapter unless the act or omission constitutes gross negligence or willful misconduct.
IV. A licensed pharmacy, whether with a physical presence or doing business though mail order, that fulfills a prescription, drug order, or protocol under this chapter is not liable for civil damages resulting from the administration of auto-injectable epinephrine under this chapter unless the act or omission constitutes gross negligence or willful misconduct.
200-N:7 Applicability. Nothing in this chapter shall be construed to:
I. Permit a trained designee to perform the duties or fill the position of a licensed campus medical professional.
II. Prohibit the administration of a pre-filled auto-injector of epinephrine by a person acting under a lawful prescription.
III. Prevent a licensed health care provider from acting within the individual’s scope of practice in administering auto-injectable epinephrine.
IV. Establish a standard of care under which a postsecondary educational institution would have a duty to employ or contract with a licensed campus medical professional or to establish guidelines for the emergency administration of epinephrine. Except as set forth in RSA 200-N:6, a postsecondary educational institution shall not be held liable for any act or omission related to the availability or non-availability of epinephrine for emergency administration on campus.
2 Dealing in or Possessing Prescription Drugs. Amend RSA 318:42, VII-a to read as follows:
VII-a. The possession and administration, with written parental authorization, of flu vaccine, immunizations, and mantoux tests for the purpose of disease prevention and tuberculosis screening by registered nurses employed or contracted by public school systems. The possession and administration of epinephrine for the emergency treatment of anaphylaxis by licensed practical nurses or registered nurses employed or contracted by public school systems or by licensed campus medical professionals in postsecondary educational institutions.
3 Effective Date. This act shall take effect 60 days after its passage.
LBAO
15-0507
01/16/15
SB 194-FN - FISCAL NOTE
AN ACT relative to epinephrine administration policies in postsecondary educational institutions.
FISCAL IMPACT:
The Departments of Health and Human Services and Education, the Board of Medicine, the University System of New Hampshire, and the Community College System of New Hampshire state this bill, as introduced, may have an indeterminable impact on state revenue and expenditures in FY 2016 and each year thereafter. There will be no fiscal impact on county or local revenue and expenditures.
METHODOLOGY:
The Department of Health and Human Services states this bill would allow a postsecondary educational institution accredited to operate in the state to develop a policy for the emergency administration of auto-injectable epinephrine when a licensed campus medical professional is not available. The Department states the bill requires the Department to establish guidelines for institutions of higher education to follow when developing such policies. The Department has identified the following potential costs associated with this bill:
• The Department assumes there would be an indeterminable cost in terms of resources required to develop the policy guidelines.
• Since some of the institutions of higher education are state institutions, there could be indeterminable costs to the state if one or more of these institutions choose to develop a policy. The trained designee would need to undergo training and there be a cost to purchase a supply of epinephrine.
The Department of Education states this bill permits postsecondary education institutions to develop policies for administration of epinephrine, and charges the Department of Health and Human Services with development of guidelines for the policies. The Department of Education does not have sufficient information to estimate the cost associated with the bill because institutions are not obligated to adopt the proposed policy, the possible costs would vary by institution, and costs cannot be known until the Department of Health and Human Services establishes the guidelines.
The Board of Medicine states the legislation would require oversight by the Board under RSA 329:17, Disciplinary Proceedings. Since the number and nature of possible proceedings cannot be predicted, the potential cost to the Board cannot be determined.
The University System of New Hampshire (USNH) states the fiscal impact on USNH institutional operations would be indeterminable but minimum since the legislation would permit, but not require the development of such a policy by a USNH institution and the law would not establish a new standard of care. The USNH further states the legislation could result in a favorable impact by reducing an institution’s liability.
The Community College System of New Hampshire states this bill is permissive and does not require a postsecondary institution to implement the policy described in the bill. The System anticipates, if any of the colleges opt to implement a policy for emergency administration of epinephrine, there would be additional interminable costs related to training and purchase, storage, and control of the auto-injectable epinephrine.