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SECOND REGULAR SESSION
HOUSE BILL NO. 2349
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE GALLICK.
5878H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o repeal sections 167.627, 167.630, 190.246, 196.990, and 321.621, RSMo, and to enact in
lieu thereof five new sections relating to epinephrine delivery devices, with penalty
provisions.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 167.627, 167.630, 190.246, 196.990, and 321.621, RSMo, are
2 repealed and five new sections enacted in lieu thereof, to be known as sections 167.627,
3 167.630, 190.246, 196.990, and 321.621, to read as follows:
167.627. 1. For purposes of this section, the following terms shall mean:
2 (1) "Epinephrine delivery device", a single-use device used for the delivery of a
3 pr emeasur ed dose of epinephrine into the human body;
4 (2) "Medication", any medicine prescribed or ordered by a physician for the treatment
5 of asthma or anaphylaxis, including without limitation inhaled bronchodilators and [ auto-
6 injectible ] epinephrine delivery devices ;
7 [ (2) ] (3) "Self-administration", a pupil's discretionary use of medication prescribed by
8 a physician or under a written treatment plan from a physician.
9 2. Each board of education and its employees and agents in this state shall grant any
10 pupil in the school authorization for the possession and self-administration of medication to
11 treat such pupil's chronic health condition, including but not limited to asthma or anaphylaxis
12 if:
13 (1) A licensed physician prescribed or ordered such medication for use by the pupil
14 and instructed such pupil in the correct and responsible use of such medication;
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
15 (2) The pupil has demonstrated to the pupil's licensed physician or the licensed
16 physician's designee, and the school nurse, if available, the skill level necessary to use the
17 medication and any device necessary to administer such medication prescribed or ordered;
18 (3) The pupil's physician has approved and signed a written treatment plan for
19 managing the pupil's chronic health condition, including asthma or anaphylaxis episodes and
20 for medication for use by the pupil. Such plan shall include a statement that the pupil is
21 capable of self-administering the medication under the treatment plan;
22 (4) The pupil's parent or guardian has completed and submitted to the school any
23 written documentation required by the school, including the treatment plan required under
24 subdivision (3) of this subsection and the liability statement required under subdivision (5) of
25 this subsection; and
26 (5) The pupil's parent or guardian has signed a statement acknowledging that the
27 school district and its employees or agents shall incur no liability as a result of any injury
28 arising from the self-administration of medication by the pupil or the administration of such
29 medication by school staf f. Such statement shall not be construed to release the school
30 district and its employees or agents from liability for negligence.
31 3. An authorization granted under subsection 2 of this section shall:
32 (1) Permit such pupil to possess and self-administer such pupil's medication while in
33 school, at a school-sponsored activity , and in transit to or from school or school-sponsored
34 activity; and
35 (2) Be ef fective only for the same school and school year for which it is granted.
36 Such authorization shall be renewed by the pupil's parent or guardian each subsequent school
37 year in accordance with this section.
38 4. Any current duplicate prescription medication, if provided by a pupil's parent or
39 guardian or by the school, shall be kept at a pupil's school in a location at which the pupil or
40 school staf f has immediate access in the event of an asthma or anaphylaxis emer gency .
41 5. The information described in subdivisions (3) and (4) of subsection 2 of this
42 section shall be kept on file at the pupil's school in a location easily accessible in the event of
43 an emer gency .
167.630. 1. As used in this section, the term "epinephrine delivery device" has
2 the same meaning given to the term in section 167.627.
3 2. Each school board may authorize a school nurse licensed under chapter 335 who is
4 employed by the school district and for whom the board is responsible for to maintain an
5 adequate supply of [ prefilled auto syringes of ] epinephrine [ with fifteen-hundredths milligram
6 or three-tenths milligram ] delivery devices at the school. The nurse shall recommend to the
7 school board the number of [ prefilled ] epinephrine [ auto syringes ] delivery devices that the
8 school should maintain.
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9 [ 2. ] 3. T o obtain [ prefilled ] epinephrine [ auto syringes ] delivery devices for a school
10 district, a prescription written by a licensed physician, a physician's assistant, or nurse
11 practitioner is required. For such prescriptions, the school district shall be designated as the
12 patient, the nurse's name shall be required, and the prescription shall be filled at a licensed
13 pharmacy .
14 [ 3. ] 4. A school nurse, contracted agent trained by a nurse, or other school employee
15 trained by and supervised by the nurse shall have the discretion to use an epinephrine [ auto
16 syringe ] delivery device on any student the school nurse, trained employee, or trained
17 contracted agent believes is having a life-threatening anaphylactic reaction based on the
18 training in recognizing an acute episode of an anaphylactic reaction. The provisions of
19 section 167.624 concerning immunity from civil liability for trained employees administering
20 lifesaving methods shall apply to trained employees administering [ a prefilled auto syringe ]
21 an epinephrine delivery device under this section. T rained contracted agents shall have
22 immunity from civil liability for administering [ a prefilled auto syringe ] an epinephrine
23 delivery device under this section.
190.246. 1. As used in this section, the following terms shall mean:
2 (1) "Eligible person, firm, or ganization or other entity", an ambulance service or
3 emer gency medical response agency , an emer gency medical responder , or an emer gency
4 medical technician who is employed by , or an enrolled member , person, firm, or ganization or
5 entity designated by , rule of the department of health and senior services in consultation with
6 other appropriate agencies. All such eligible persons, firms, or ganizations or other entities
7 shall be subject to the rules promulgated by the director of the department of health and senior
8 services;
9 (2) "Emergency health care provider":
10 (a) A physician licensed pursuant to chapter 334 with knowledge and experience in
11 the delivery of emer gency care; or
12 (b) A hospital licensed pursuant to chapter 197 that provides emer gency care ;
13 (3) "Epinephrine delivery device", a single-use device used for the delivery of a
14 pr emeasur ed dose of epinephrine into the human body .
15 2. Possession and use of epinephrine [ auto-injector ] delivery devices shall be limited
16 as follows:
17 (1) No person shall use an epinephrine [ auto-injector ] delivery device unless such
18 person has successfully completed a training course in the use of epinephrine [ auto-injector ]
19 delivery devices approved by the director of the department of health and senior services.
20 Nothing in this section shall prohibit the use of an epinephrine [ auto-injector ] delivery
21 device:
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22 (a) By a health care professional licensed or certified by this state who is acting
23 within the scope of his or her practice; or
24 (b) By a person acting pursuant to a lawful prescription;
25 (2) Every person, firm, or ganization and entity authorized to possess and use
26 epinephrine [ auto-injector ] delivery devices pursuant to this section shall use, maintain and
27 dispose of such devices in accordance with the rules of the department; and
28 (3) Every use of an epinephrine [ auto-injector ] delivery device pursuant to this
29 section shall immediately be reported to the emer gency health care provider .
30 3. (1) Use of an epinephrine [ auto-injector ] delivery device pursuant to this section
31 shall be considered first aid or emer gency treatment for the purpose of any law relating to
32 liability .
33 (2) Purchase, acquisition, possession or use of an epinephrine [ auto-injector ] delivery
34 device pursuant to this section shall not constitute the unlawful practice of medicine or the
35 unlawful practice of a profession.
36 (3) Any person otherwise authorized to sell or provide an epinephrine [ auto-injector ]
37 delivery device may sell or provide it to a person authorized to possess it pursuant to this
38 section.
39 4. Any person, firm, or ganization or entity that violates the provisions of this section
40 is guilty of a class B misdemeanor .
196.990. 1. As used in this section, the following terms shall mean:
2 (1) "Administer", the direct application of an epinephrine [ auto-injector ] delivery
3 device to the body of an individual;
4 (2) "Authorized entity", any entity or or ganization at or in connection with which
5 aller gens capable of causing anaphylaxis may be present including, but not limited to,
6 qualified first responders, as such term is defined in section 321.621, facilities licensed
7 under chapter 198, restaurants, recreation camps, youth sports leagues, child car e facilities,
8 amusement parks, and sports arenas. "Authorized entity" shall not include any public school
9 or public charter school;
10 (3) "Epinephrine [ auto-injector ] delivery device ", a single-use device used for the
11 [ automatic injection ] delivery of a premeasured dose of epinephrine into the human body;
12 (4) "Physician", a physician licensed in this state under chapter 334;
13 (5) "Provide", the supply of one or more epinephrine [ auto-injectors ] delivery
14 devices to an individual;
15 (6) "Self-administration", a person's discretionary use of an epinephrine [ auto-
16 injector ] delivery device .
17 2. A physician may prescribe epinephrine [ auto-injectors ] delivery devices in the
18 name of an authorized entity for use in accordance with this section, and pharmacists,
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19 physicians, and other persons authorized to dispense prescription medications may dispense
20 epinephrine [ auto-injectors ] delivery devices under a prescription issued in the name of an
21 authorized entity .
22 3. An authorized entity may acquire and stock a supply of epinephrine [ auto-
23 injectors ] delivery devices under a prescription issued in accordance with this section. Such
24 epinephrine [ auto-injectors ] delivery devices shall be stored in a location readily accessible
25 in an emer gency and in accordance with the epinephrine [ auto-injector's ] delivery device's
26 instructions for use and any additional requirements established by the department of health
27 and senior services by rule. An authorized entity shall designate employees or agents who
28 have completed the training required under this section to be responsible for the storage,
29 maintenance, and general oversight of epinephrine [ auto-injectors ] delivery devices acquired
30 by the authorized entity .
31 4. An authorized entity that acquires a supply of epinephrine [ auto-injectors ] delivery
32 devices under a prescription issued in accordance with this section shall ensure that:
33 (1) Expected epinephrine [ auto-injector ] delivery device users receive training in
34 recognizing symptoms of severe aller gic reactions including anaphylaxis and the use of
35 epinephrine [ auto-injectors ] delivery devices from a nationally recognized or ganization
36 experienced in training laypersons in emer gency health treatment or another entity or person
37 approved by the department of health and senior services;
38 (2) All epinephrine [ auto-injectors ] delivery devices are maintained and stored
39 according to the epinephrine [ auto-injector's ] delivery device's instructions for use;
40 (3) Any person who provides or administers an epinephrine [ auto-injector ] delivery
41 device to an individual who the person believes in good faith is experiencing anaphylaxis
42 activates the emer gency medical services system as soon as possible; and
43 (4) A proper review of all situations in which an epinephrine [ auto-injector ] delivery
44 device is used to render emer gency care is conducted.
45 5. Any authorized entity that acquires a supply of epinephrine [ auto-injectors ]
46 delivery devices under a prescription issued in accordance with this section shall notify the
47 emer gency communications district or the ambulance dispatch center of the primary provider
48 of emer gency medical services where the epinephrine [ auto-injectors ] delivery devices are to
49 be located within the entity's facility .
50 6. No person shall provide or administer an epinephrine [ auto-injector ] delivery
51 device to any individual who is under eighteen years of age without the verbal consent of a
52 parent or guardian who is present at the time when provision or administration of the
53 epinephrine [ auto-injector ] delivery device is needed. Provided, however , that a person may
54 provide or administer an epinephrine [ auto-injector ] delivery device to such an individual
55 without the consent of a parent or guardian if the parent or guardian is not physically present
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56 and the person reasonably believes the individual shall be in imminent danger without the
57 provision or administration of the epinephrine [ auto-injector ] delivery device .
58 7. The following persons and entities shall not be liable for any injuries or related
59 damages that result from the administration or self-administration of an epinephrine [ auto-
60 injector ] delivery device in accordance with this section that may constitute ordinary
61 negligence:
62 (1) An authorized entity that possesses and makes available epinephrine [ auto-
63 injectors ] delivery devices and its employees, agents, and other trained persons;
64 (2) Any person who uses an epinephrine [ auto-injector ] delivery device made
65 available under this section;
66 (3) A physician that prescribes epinephrine [ auto-injectors ] delivery devices to an
67 authorized entity; or
68 (4) Any person or entity that conducts the training described in this section.
69
70 Such immunity does not apply to acts or omissions constituting a reckless disregard for the
71 safety of others or willful or wanton conduct. The administration of an epinephrine [ auto-
72 injector ] delivery device in accordance with this section shall not be considered the practice
73 of medicine. The immunity from liability provided under this subsection is in addition to and
74 not in lieu of that provided under section 537.037. An authorized entity located in this state
75 shall not be liable for any injuries or related damages that result from the provision or
76 administration of an epinephrine [ auto-injector ] delivery device by its employees or agents
77 outside of this state if the entity or its employee or agent is not liable for such injuries or
78 related damages under the laws of the state in which such provision or administration
79 occurred. No trained person who is in compliance with this section and who in good faith and
80 exercising reasonable care fails to administer an epinephrine [ auto-injector ] delivery device
81 shall be liable for such failure.
82 8. All basic life support ambulances and stretcher vans operated in the state shall be
83 equipped with epinephrine [ auto-injectors ] delivery devices and be staff ed by at least one
84 individual trained in the use of epinephrine [ auto-injectors ] delivery devices .
85 9. The provisions of this section shall apply in all counties within the state and any
86 city not within a county .
87 10. Nothing in this section shall be construed as superseding the provisions of section
88 167.630.
321.621. 1. For the purposes of this section, the following terms mean:
2 (1) "Epinephrine delivery device", a single-use device used for the delivery of a
3 pr emeasur ed dose of epinephrine into the human body;
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4 (2) "Qualified first responder" [ shall mean ] , any state and local law enforcement
5 agency staff , fire department personnel, fire district personnel, or licensed emer gency medical
6 technician who is acting under the directives and established protocols of a medical director
7 who comes in contact with a person suf fering from an anaphylactic reaction and who has
8 received training in recognizing and responding to anaphylactic reactions and the
9 administration of epinephrine [ auto-injector ] delivery devices to a person suf fering from
10 an apparent anaphylactic reaction[ . ] ;
11 (3) "Qualified first responder agencies" [ shall mean ] , any state or local law
12 enforcement agency , fire department, or ambulance service that provides documented training
13 to its staff related to the administration of epinephrine [ auto-injector ] delivery devices in an
14 apparent anaphylactic reaction.
15 2. The director of the department of health and senior services, if a licensed
16 physician, may issue a statewide standing order for epinephrine [ auto-injector ] delivery
17 devices for adult patients to fire protection districts in nonmetropolitan areas in Missouri as
18 such areas are determined according to the United States Census Bureau's American
19 Community Survey , based on the most recent of five-year period estimate data in which the
20 final year of the estimate ends in either zero or five. If the director of the department of health
21 and senior services is not a licensed physician, the department of health and senior services
22 may employ or contract with a licensed physician who may issue such a statewide order with
23 the express consent of the director .
24 3. Possession and use of epinephrine [ auto-injector ] delivery devices for adult
25 patients shall be limited as follows:
26 (1) No person shall use an epinephrine [ auto-injector ] delivery device pursuant to this
27 section unless such person has successfully completed a training course in the use of
28 epinephrine [ auto-injector ] delivery devices for adult patients approved by the director of the
29 department of health and senior services. Nothing in this section shall prohibit the use of an
30 epinephrine [ auto-injector ] delivery device:
31 (a) By a health care professional licensed or certified by this state who is acting
32 within the scope of his or her practice; or
33 (b) By a person acting pursuant to a lawful prescription;
34 (2) Every person, firm, or ganization and entity authorized to possess and use
35 epinephrine [ auto-injector ] delivery devices for adult patients pursuant to this section shall
36 use, maintain and dispose of such devices for adult patients in accordance with the rules of the
37 department; and
38 (3) Every use of an epinephrine [ auto-injector ] delivery device pursuant to this
39 section shall immediately be reported to the emer gency health care provider as defined in
40 section 190.246.
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41 4. (1) Use of an epinephrine [ auto-injector ] delivery device pursuant to this section
42 shall be considered first aid or emer gency treatment for the purpose of any law relating to
43 liability .
44 (2) Purchase, acquisition, possession or use of an epinephrine [ auto-injector ] delivery
45 device pursuant to this section shall not constitute the unlawful practice of medicine or the
46 unlawful practice of a profession.
47 (3) Any person otherwise authorized to sell or provide an epinephrine [ auto-injector ]
48 delivery device may sell or provide it to a person authorized to possess it pursuant to this
49 section.
50 5. (1) There is hereby created in the state treasury the "Epinephrine [ Auto-injector ]
51 Delivery Devices for Fire Personnel Fund", which shall consist of [ money collected under
52 this section ] moneys appr opriated to the fund . The state treasurer shall be custodian of the
53 fund. In accordance with sections 30.170 and 30.180, the state treasurer may approve
54 disbursements. The moneys in the fund as set forth in this section shall be subject to
55 appropriation by the general assembly for the particular purpose for which collected. The
56 fund shall be a dedicated fund and money in the fund shall be used solely by the department
57 of health and senior services for the purposes of providing epinephrine [ auto-injector ]
58 delivery devices for adult patients to qualified first responder agencies as used in this section.
59 (2) Notwithstanding the provisions of section 33.080 to the contrary , any moneys
60 remaining in the fund at the end of the biennium shall not revert to the credit of the general
61 revenue fund.
62 (3) The state treasurer shall invest moneys in the fund in the same manner as other
63 funds are invested. Any interest and moneys earned on such investments shall be credited to
64 the fund.
✔
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