SB2058sam001 101ST GENERAL ASSEMBLY

Sen. Laura M. Murphy

Filed: 3/15/2019

10100SB2058sam001 LRB101 08879 AWJ 57994 a

AMENDMENT TO SENATE BILL 2058

AMENDMENT NO. ______. Amend Senate Bill 2058 by replacing everything after the enacting clause with the following:

"Section 5. The Park District Code is amended by adding Section 8-25 as follows:

(70 ILCS 1205/8-25 new)

Sec. 8-25. Administration of asthma medication, epinephrine injectors, and opioid antagonist in after-school programs or recreational camps; asthma episode emergency response protocol.

(a) As used in this Section:

"After-school program" means a program sponsored by a park district that is organized at the park district during the hours after school, during recess from school, or on weekends. These activities may include, but are not limited to, academic support, arts, music, sports, cultural enrichment, or other recreation, health promotion and diseases prevention, life skills and work and career development, or youth leadership development.

"Asthma action plan" means a written plan developed with a program participant's medical provider to help control the program participant's asthma. The goal of an asthma action plan is to reduce or prevent flare-ups and emergency department visits through day-to-day management and to serve as a program participant-specific document to be referenced in the event of an asthma episode.

"Asthma episode emergency response protocol" means a procedure to provide assistance to a program participant experiencing symptoms of wheezing, coughing, shortness of breath, chest tightness, or breathing difficulty.

"Asthma medication" means quick-relief asthma medication, including albuterol or other short-acting bronchodilators, that is approved by the United States Food and Drug Administration for the treatment of respiratory distress. "Asthma medication" includes medication delivered through a device, including a metered-dose inhaler with a reusable or disposable spacer or a nebulizer with a mouthpiece or mask.

"Epinephrine injector" means an auto-injector approved by the United States Food and Drug Administration for the administration of epinephrine and a pre-filled syringe approved by the United States Food and Drug Administration and used for the administration of epinephrine that contains a pre-measured dose of epinephrine that is equivalent to the dosages used in an auto-injector.

"Opioid antagonist" means a drug that binds to opioid receptors and blocks or inhibits the effect of opioids acting on those receptors, including, but not limited to, naloxone hydrochloride or any other similarly acting drug approved by the U.S. Food and Drug Administration.

"Program participant" means an individual participating in an after-school program or recreational camp.

"Park district" means park districts organized under this Code or the Chicago Park District Act.

"Respiratory distress" means the perceived or actual presence of wheezing, coughing, shortness of breath, chest tightness, breathing difficulty, or any other symptoms consistent with asthma. "Respiratory distress" may be categorized as "mild-to-moderate" or "severe".

"Self-administration" means a program participant's discretionary use of his or her prescribed asthma medication or epinephrine injector.

"Standing protocol" may be issued by (i) a physician licensed to practice medicine in all its branches, (ii) a licensed physician assistant with prescriptive authority, or (iii) a licensed advanced practice registered nurse with prescriptive authority.

"Trained personnel" means any park district employee or volunteer who has completed training under subsection (i) to recognize and respond to anaphylaxis, opioid overdose, and respiratory distress.

"Undesignated asthma medication" means asthma medication prescribed in the name of a park district.

"Undesignated epinephrine injector" means an epinephrine injector prescribed in the name of a park district.

(b) The park district must train all personnel working at after-school programs or recreational camps as provided in subsections (m), (n), and (o) and, after training, trained personnel must: (i) provide an undesignated or program participant-specific epinephrine injector to a program participant for self-administration only that meets the program participant's prescription on file; (ii) administer an undesignated or program participant-specific epinephrine injector that meets the prescription on file to any program participant who has an Individual Health Care Action Plan, Illinois Food Allergy Emergency Action Plan and Treatment Authorization Form, plan pursuant to Section 504 of the federal Rehabilitation Act of 1973, or individualized education program plan that authorizes the use of an epinephrine injector; (iii) administer an undesignated or program participant-specific epinephrine injector to a program participant that the trained personnel in good faith believes is having an anaphylactic reaction; (iv) administer an opioid antagonist to a program participant that the trained personnel in good faith believes is having an opioid overdose; (v) provide undesignated or program participant-specific asthma medication to a program participant for self-administration only that meets the program participant's prescription on file; (vi) administer undesignated or program participant-specific asthma medication that meets the prescription on file to any program participant who has an Individual Health Care Action Plan, asthma action plan, plan pursuant to Section 504 of the federal Rehabilitation Act of 1973, or individualized education program plan that authorizes the use of asthma medication; and (vii) administer undesignated or program participant-specific asthma medication to a program participant that the trained personnel believes in good faith is having respiratory distress.

Trained personnel is not required to administer an undesignated or program participant-specific epinephrine injector, an opioid antagonist, or an undesignated or program participant-specific asthma medication to a program participant if the program participant indicates that they will self-administer. Trained personnel may administer an undesignated or program participant-specific epinephrine injector, an opioid antagonist, or an undesignated or program participant-specific asthma medication to any person that is not a program participant on park district property or at a park district activity if the trained personnel in good faith believes the person is in need of the undesignated or program participant-specific epinephrine injector, an opioid antagonist, or an undesignated or program participant-specific asthma medication.

(c) The park district must inform the parents or guardians of the program participant, in writing, that the park district and its employees and agents, including a physician, physician assistant, or advanced practice registered nurse providing a standing protocol and a prescription for park district undesignated epinephrine injectors, an opioid antagonist, or undesignated asthma medication, are to incur no liability or professional discipline, except for willful and wanton conduct, as a result of any injury arising from the administration of asthma medication, an epinephrine injector, or an opioid antagonist regardless of whether authorization was given by the program participant's parents or guardians or by the program participant's physician, physician assistant, or advanced practice registered nurse. The parents or guardians of the program participant must sign a statement acknowledging that the park district and its employees and agents are to incur no liability, except for willful and wanton conduct, as a result of any injury arising from the administration of asthma medication, an epinephrine injector, or an opioid antagonist regardless of whether authorization was given by the program participant's parents or guardians or by the program participant's physician, physician assistant, or advanced practice registered nurse and that the parents or guardians must indemnify and hold harmless the park district and its employees and agents against any claims, except a claim based on willful and wanton conduct, arising out of the administration of asthma medication, an epinephrine injector, or an opioid antagonist regardless of whether authorization was given by the program participant's parents or guardians or by the program participant's physician, physician assistant, or advanced practice registered nurse.

(d) When trained personnel administers an undesignated or program participant-specific epinephrine injector to a person whom the trained personnel in good faith believes is having an anaphylactic reaction, administers an opioid antagonist to a person whom the trained personnel in good faith believes is having an opioid overdose, or administers undesignated or program participant-specific asthma medication to a person whom the trained personnel in good faith believes is having respiratory distress, notwithstanding the lack of notice to the parents or guardians of the program participant or the absence of the parents or guardians signed statement acknowledging no liability, except for willful and wanton conduct, the park district and its employees and agents, including a physician, a physician assistant, or an advanced practice registered nurse providing standing protocol and a prescription for undesignated or program participant-specific epinephrine injectors, an opioid antagonist, or undesignated or program participant-specific asthma medication, are to incur no liability or professional discipline, except for willful and wanton conduct, as a result of any injury arising from the use of an undesignated or program participant-specific epinephrine injector, the use of an opioid antagonist, or the use of undesignated or program participant-specific asthma medication, regardless of whether authorization was given by the program participant's parents or guardians or by the program participant's physician, physician assistant, or advanced practice registered nurse.

(e) Provided that the requirements of this Section are fulfilled, trained personnel must administer an undesignated or program participant-specific epinephrine injector to a program participant whom the trained personnel in good faith believes to be having an anaphylactic reaction (i) while at an after-school program or recreational camp, (ii) while at a park district-sponsored activity related to an after-school program or recreational camp, (iii) while under the supervision of after-school program or recreational camp personnel, or (iv) before or after after-school programs or recreational camps, such as while being transported in park district vehicles to or from an after-school program or recreational camp. Trained personnel may carry undesignated epinephrine injectors on his or her person while in a park district or at a park district-sponsored activity.

(f) Provided that the requirements of this Section are fulfilled, trained personnel must administer an opioid antagonist to a program participant whom the trained personnel in good faith believes to be having an opioid overdose (i) while at an after-school program or recreational camp, (ii) while at a park district-sponsored activity related to an after-school program or recreational camp, (iii) while under the supervision of after-school program or recreational camp personnel, or (iv) before or after after-school programs or recreational camps, such as while being transported in park district vehicles to or from an after-school program or recreational camp. Trained personnel may carry an opioid antagonist on his or her person while in a park district or at a park district-sponsored activity.

(g) If the requirements of this Section are met, trained personnel must administer undesignated or program participant-specific asthma medication to a program participant whom the trained personnel in good faith believes to be experiencing respiratory distress (i) while at an after-school program or recreational camp, (ii) while at a park district-sponsored activity related to an after-school program or recreational camp, (iii) while under the supervision of after-school program or recreational camp personnel, or (iv) before or after after-school programs or recreational camps, such as while being transported in park district vehicles to or from an after-school program or recreational camp. Trained personnel may carry undesignated asthma medication on his or her person while in a park district or at a park district-sponsored activity.

(h) The park district must maintain a supply of undesignated epinephrine injectors in secure locations that are accessible before, during, and after an after-school program or recreational camp where an allergic person is most at risk. A physician, a physician assistant who has prescriptive authority in accordance with Section 7.5 of the Physician Assistant Practice Act of 1987, or an advanced practice registered nurse who has prescriptive authority in accordance with Section 65-40 of the Nurse Practice Act may prescribe undesignated epinephrine injectors in the name of the park district to be maintained for use when necessary. The supply of undesignated epinephrine injectors shall be maintained in accordance with the manufacturer's instructions.

The park district shall maintain a supply of an opioid antagonist in secure locations where an individual may have an opioid overdose. A health care professional who has been delegated prescriptive authority for opioid antagonists in accordance with Section 5-23 of the Substance Use Disorder Act may prescribe opioid antagonists in the name of the park district, to be maintained for use when necessary. The supply of opioid antagonists shall be maintained in accordance with the manufacturer's instructions.

The park district must maintain a supply of undesignated asthma medication in secure locations that are accessible before, during, or after an after-school program or recreational camp where a person is most at risk. A physician, a physician assistant who has prescriptive authority under Section 7.5 of the Physician Assistant Practice Act of 1987, or an advanced practice registered nurse who has prescriptive authority under Section 65-40 of the Nurse Practice Act may prescribe undesignated asthma medication in the name of the park district to be maintained for use when necessary. The supply of undesignated asthma medication must be maintained in accordance with the manufacturer's instructions.

(i) The park district shall pay for the costs of the undesignated epinephrine injectors, opioid antagonists, and undesignated asthma medication.

(j) Upon any administration of an epinephrine injector or an opioid antagonist, a park district must immediately call 9-1-1 or, if 9-1-1 is not available, other local emergency medical services and notify the program participant's parent, guardian, or emergency contact, if known.

(k) Within 24 hours of the administration of an undesignated or program participant-specific epinephrine injector, a park district must notify the physician, physician assistant, or advanced practice registered nurse who provided the standing protocol and a prescription for the undesignated or program participant-specific epinephrine injector of its use.

Within 24 hours after the administration of an opioid antagonist, a park district must notify the health care professional who provided the prescription for the opioid antagonist of its use.

Within 24 hours after the administration of undesignated or program participant-specific asthma medication, a park district must notify the program participant's parent or guardian or emergency contact, if known, and the physician, physician assistant, or advanced practice registered nurse who provided the standing protocol and a prescription for the undesignated or program participant-specific asthma medication of its use. The park district must follow up with the trained personnel, if available, and may, with the consent of the child's parent or guardian, notify the child's health care provider of record, as determined under this Section, of its use.

(l) Prior to the administration of an undesignated or program participant-specific epinephrine injector, trained personnel must submit to the park district's administration proof of completion of a training curriculum to recognize and respond to anaphylaxis that meets the requirements of subsection (m). Training must be completed annually. The park district must maintain records related to the training curriculum and trained personnel.

Prior to the administration of an opioid antagonist, trained personnel must submit to the park district's administration proof of completion of a training curriculum to recognize and respond to an opioid overdose, which curriculum must meet the requirements of subsection (n). Training must be completed annually. Trained personnel must also submit to the park district's administration proof of cardiopulmonary resuscitation and automated external defibrillator certification. The park district must maintain records relating to the training curriculum and the trained personnel.

Prior to the administration of undesignated or program participant-specific asthma medication, trained personnel must submit to the park district's administration proof of completion of a training curriculum to recognize and respond to respiratory distress, which must meet the requirements of subsection (o). Training must be completed annually, and the park district must maintain records relating to the training curriculum and the trained personnel.

(m) A training curriculum to recognize and respond to anaphylaxis, including the administration of an undesignated or program participant-specific epinephrine injector, may be conducted online or in person.

Training must include, but is not limited to:

(1) how to recognize signs and symptoms of an allergic reaction, including anaphylaxis;

(2) how to administer an epinephrine injector; and

(3) a test demonstrating competency of the knowledge required to recognize anaphylaxis and administer an epinephrine injector.

Training may also include, but is not limited to:

(A) a review of high-risk areas within a park district and its related facilities;

(B) steps to take to prevent exposure to allergens;

(C) emergency follow-up procedures, including the importance of calling 9-1-1 or, if 9-1-1 is not available, other local emergency medical services;

(D) how to respond to a program participant with a known allergy, as well as a program participant with a previously unknown allergy; and

(E) other criteria as determined by the park district.

(n) A training curriculum to recognize and respond to an opioid overdose, including the administration of an opioid antagonist, may be conducted online or in person. The training must comply with any training requirements under Section 5-23 of the Substance Use Disorder Act and the corresponding rules. It must include, but is not limited to:

(1) how to recognize symptoms of an opioid overdose;

(2) information on drug overdose prevention and recognition;

(3) how to perform rescue breathing and resuscitation;

(4) how to respond to an emergency involving an opioid overdose;

(5) opioid antagonist dosage and administration;

(6) the importance of calling 9-1-1 or, if 9-1-1 is not available, other local emergency medical services;

(7) care for the overdose victim after administration of the overdose antagonist;

(8) a test demonstrating competency of the knowledge required to recognize an opioid overdose and administer a dose of an opioid antagonist; and

(9) other criteria as determined by the park district.

(o) A training curriculum to recognize and respond to respiratory distress, including the administration of undesignated or program participant-specific asthma medication, may be conducted online or in person. The training must include, but is not limited to:

(1) how to recognize symptoms of respiratory distress and how to distinguish respiratory distress from anaphylaxis;

(2) how to respond to an emergency involving respiratory distress;

(3) asthma medication dosage and administration;

(4) the importance of calling 9-1-1 or, if 9-1-1 is not available, other local emergency medical services;

(5) a test demonstrating competency of the knowledge required to recognize respiratory distress and administer asthma medication; and

(6) other criteria as determined by the park district.

(p) Each park district shall adopt, before January 1, 2021, an asthma episode emergency response protocol similar to the model asthma episode emergency response protocol adopted by the State Board of Education under subsection (j-10) of Section 22-30 of the School Code.

(q) Every 2 years, trained personnel shall complete an in-person or online training program on the management of asthma, the prevention of asthma symptoms, and emergency response in the park district setting.

(r) Nothing in this Section shall limit the amount of or supply of epinephrine injectors that a park district or program participant may carry or maintain.

Section 10. The Chicago Park District Act is amended by adding Section 26.10-13 as follows:

(70 ILCS 1505/26.10-13 new)

Sec. 26.10-13. Administration of asthma medication, epinephrine injectors, and opioid antagonist in after-school programs or recreational camps; asthma episode emergency response protocol. The Chicago Park District is subject to Section 8-25 of the Park District Code.".