[Congressional Record Volume 150, Number 124 (Tuesday, October 5, 2004)]
[House]
[Pages H8074-H8079]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ASTHMATIC SCHOOLCHILDREN'S TREATMENT AND HEALTH MANAGEMENT ACT OF 2004
Mr. BARTON of Texas. Mr. Speaker, I move to suspend the rules and
pass the bill (H.R. 2023) to give a preference regarding States that
require schools to allow students to self-administer medication to
treat that student's asthma or anaphylaxis, and for other purposes, as
amended.
The Clerk read as follows:
H.R. 2023
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Asthmatic Schoolchildren's
Treatment and Health Management Act of 2004''.
SEC. 2. FINDINGS.
The Congress finds the following:
(1) Asthma is a chronic condition requiring lifetime,
ongoing medical intervention.
(2) In 1980, 6,700,000 Americans had asthma.
(3) In 2001, 20,300,000 Americans had asthma; 6,300,000
children under age 18 had asthma.
(4) The prevalence of asthma among African-American
children was 40 percent greater than among Caucasian
children, and more than 26 percent of all asthma deaths are
in the African-American population.
(5) In 2000, there were 1,800,000 asthma-related visits to
emergency departments (more than 728,000 of these involved
children under 18 years of age).
(6) In 2000, there were 465,000 asthma-related
hospitalizations (214,000 of these involved children under 18
years of age).
(7) In 2000, 4,487 people died from asthma, and of these
223 were children.
(8) According to the Centers for Disease Control and
Prevention, asthma is a common cause of missed school days,
accounting for approximately 14,000,000 missed school days
annually.
(9) According to the New England Journal of Medicine,
working parents of children with asthma lose an estimated
$1,000,000,000 a year in productivity.
(10) At least 30 States have legislation protecting the
rights of children to carry and self-administer asthma
metered-dose inhalers, and at least 18 States expand this
protection to epinephrine auto-injectors.
(11) Tragic refusals of schools to permit students to carry
their inhalers and auto-injectable epinephrine have occurred,
some resulting in death and spawning litigation.
(12) School district medication policies must be developed
with the safety of all students in mind. The immediate and
correct use of asthma inhalers and auto-injectable
epinephrine are necessary to avoid serious respiratory
complications and improve health care outcomes.
(13) No school should interfere with the patient-physician
relationship.
(14) Anaphylaxis, or anaphylactic shock, is a systemic
allergic reaction that can kill within
[[Page H8075]]
minutes. Anaphylaxis occurs in some asthma patients.
According to the American Academy of Allergy, Asthma, and
Immunology, people who have experienced symptoms of
anaphylaxis previously are at risk for subsequent reactions
and should carry an epinephrine auto-injector with them at
all times, if prescribed.
(15) An increasing number of students and school staff have
life-threatening allergies. Exposure to the affecting
allergen can trigger anaphylaxis. Anaphylaxis requires prompt
medical intervention with an injection of epinephrine.
SEC. 3. PREFERENCE FOR STATES THAT ALLOW STUDENTS TO SELF-
ADMINISTER MEDICATION TO TREAT ASTHMA AND
ANAPHYLAXIS.
(a) Amendments.--Section 399L of the Public Health Service
Act (42 U.S.C. 280g) is amended--
(1) by redesignating subsection (d) as subsection (e); and
(2) by inserting after subsection (c) the following:
``(d) Preference for States That Allow Students to Self-
Administer Medication to Treat Asthma and Anaphylaxis.--
``(1) Preference.--The Secretary, in making any grant under
this section or any other grant that is asthma-related (as
determined by the Secretary) to a State, shall give
preference to any State that satisfies the following:
``(A) In general.--The State must require that each public
elementary school and secondary school in that State will
grant to any student in the school an authorization for the
self-administration of medication to treat that student's
asthma or anaphylaxis, if--
``(i) a health care practitioner prescribed the medication
for use by the student during school hours and instructed the
student in the correct and responsible use of the medication;
``(ii) the student has demonstrated to the health care
practitioner (or such practitioner's designee) and the school
nurse (if available) the skill level necessary to use the
medication and any device that is necessary to administer
such medication as prescribed;
``(iii) the health care practitioner formulates a written
treatment plan for managing asthma or anaphylaxis episodes of
the student and for medication use by the student during
school hours; and
``(iv) the student's parent or guardian has completed and
submitted to the school any written documentation required by
the school, including the treatment plan formulated under
clause (iii) and other documents related to liability.
``(B) Scope.--An authorization granted under subparagraph
(A) must allow the student involved to possess and use his or
her medication--
``(i) while in school;
``(ii) while at a school-sponsored activity, such as a
sporting event; and
``(iii) in transit to or from school or school-sponsored
activities.
``(C) Duration of authorization.--An authorization granted
under subparagraph (A)--
``(i) must be effective only for the same school and school
year for which it is granted; and
``(ii) must be renewed by the parent or guardian each
subsequent school year in accordance with this subsection.
``(D) Backup medication.--The State must require that
backup medication, if provided by a student's parent or
guardian, be kept at a student's school in a location to
which the student has immediate access in the event of an
asthma or anaphylaxis emergency.
``(E) Maintenance of information.--The State must require
that information described in subparagraphs (A)(iii) and
(A)(iv) be kept on file at the student's school in a location
easily accessible in the event of an asthma or anaphylaxis
emergency.
``(2) Rule of construction.--Nothing in this subsection
creates a cause of action or in any other way increases or
diminishes the liability of any person under any other law.
``(3) Definitions.--For purposes of this subsection:
``(A) The terms `elementary school' and `secondary school'
have the meaning given to those terms in section 9101 of the
Elementary and Secondary Education Act of 1965.
``(B) The term `health care practitioner' means a person
authorized under law to prescribe drugs subject to section
503(b) of the Federal Food, Drug, and Cosmetic Act.
``(C) The term `medication' means a drug as that term is
defined in section 201 of the Federal Food, Drug, and
Cosmetic Act and includes inhaled bronchodilators and auto-
injectable epinephrine.
``(D) The term `self-administration' means a student's
discretionary use of his or her prescribed asthma or
anaphylaxis medication, pursuant to a prescription or written
direction from a health care practitioner.''.
(b) Applicability.--The amendments made by this section
shall apply only with respect to grants made on or after the
date that is 9 months after the date of the enactment of this
Act.
SEC. 4. SENSE OF CONGRESS COMMENDING CDC FOR ITS STRATEGIES
FOR ADDRESSING ASTHMA WITHIN A COORDINATED
SCHOOL HEALTH PROGRAM.
The Congress--
(1) commends the Centers for Disease Control and Prevention
for identifying and creating ``Strategies for Addressing
Asthma Within a Coordinated School Program'' for schools to
address asthma; and
(2) encourages all schools to review these strategies and
adopt policies that will best meet the needs of their student
population.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Texas (Mr. Barton) and the gentleman from Ohio (Mr. Brown) each will
control 20 minutes.
The Chair recognizes the gentleman from Texas (Mr. Barton).
General Leave
Mr. BARTON of Texas. Mr. Speaker, I ask unanimous consent that all
Members may have 5 legislative days within which to revise and extend
their remarks and include extraneous material on H.R. 2023, as amended.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. BARTON of Texas. Mr. Speaker, I yield myself of such time as I
may consume.
Mr. Speaker, I rise today in strong support of H.R. 2023, the
Asthmatic Schoolchildren's Treatment and Health Management Act,
sponsored by the Energy and Commerce subcommittee chairman, the
gentleman from Florida (Mr. Stearns).
Over the past 15 years, the number of Americans diagnosed with asthma
has nearly doubled to an estimated 17 million people, including 5
million children. The Federal Government has invested significant
resources to strengthen and improve asthma research and prevention
activities. The Department of Health and Human Services fiscal 2005
budget request includes approximately $321 million for direct asthma
programs.
When asthma strikes, airways in the lungs become inflamed and
constricted, causing coughing, wheezing and difficulty breathing. Each
year, nearly half a million Americans are hospitalized and,
unfortunately and sadly, more than 5,000 die from asthma. Several
medications, when properly administered in a timely fashion, are now
available to treat asthma and/or anaphylaxis.
Unfortunately, some schools do not permit students to self-administer
medication for asthma even though the parent or guardian of the student
has authorized the use of the medication and it is recommended by a
health care provider, resulting in an unnecessary delay of potentially
life-saving treatments.
H.R. 2023 directs the Secretary of Health and Human Services to give
preference when making asthma-related grants to States that require
schools to allow students to self-administer medications. H.R. 2023
does not federally mandate that States allow children to carry
prescribed asthma medication in schools. The intent of the bill is to
incentivize States to do the right thing by granting preference for
asthma-related health program dollars to the States that have
regulations that put the parents' and the children's safety first.
Mr. Speaker, I can say, as one of the founding members of Asthma
Awareness Day here on Capitol Hill, I am very proud that now as
chairman of the Committee on Energy and Commerce, with the strong
support and leadership of the gentleman from Florida (Mr. Stearns), we
can bring this bill forward. I would urge its adoption.
Mr. Speaker, I ask unanimous consent to yield the balance of my time
to manage the bill to the subcommittee chairman, the gentleman from
Florida (Mr. Stearns).
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. BROWN of Ohio. Mr. Speaker, I yield myself 2 minutes.
Mr. Speaker, millions of Americans, including my wife, suffer from
asthma. In a classroom of 30 children, on the average, three are likely
to have asthma. The disease killed more than 200 American children in
the year 2000. Some States, however, prohibit children from carrying
emergency asthma medicine to school. Some of these prohibitions occur
despite the fact that parents have authorized the medication's use.
This creates an unnecessary delay in administering these medications,
when it only takes seconds for an asthma attack sometimes to turn
deadly.
The ASTHMA Act, H.R. 2023, encourages States to modernize their laws.
I commend my friend the gentleman from Florida (Mr. Stearns) for his
leadership on this legislation and my friend, the gentleman from New
York (Mr. Towns), for introducing the proposal.
The Centers for Disease Control and Prevention has done terrific work
in examining and recommending strategies for combating asthma in
school-
[[Page H8076]]
based situations and has laid out six strategies for addressing asthma
in schools. This bill also commends those efforts.
Allowing children to self-administer their asthma medication will
save lives and will make our schools healthier and safer. I am pleased
to support this important legislation.
Mr. STEARNS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I am proud also to author this bill, H.R. 2023, the
Asthmatic Student Treatment and Health Management Act, ASTHMA, with my
colleague, the gentleman from Rhode Island (Mr. Kennedy). He and I have
been working together on this for some time, and we are pleased it came
to the House floor today. It has been a long haul.
I also want to thank the gentleman from Texas (Chairman Barton) for
his early support and providing the leadership in this whole series of
legislative initiatives. We introduced this bill, the gentleman from
Rhode Island (Mr. Kennedy) and I, in 2003 on Asthma Awareness Day.
Frankly, I think it has been building momentum ever since.
This bill provides incentives for States to guarantee students can
carry and use prescribed asthma medication while they are at school. It
is not a mandate, and, frankly incurs no new spending.
The ``zero tolerance'' movement of the 1980s and 1990s had the
unintended consequence of depriving students of immediate access to
their prescribed medication. Often there is a signaling effect in the
States or industry merely from the existence of Federal legislation,
sort of a chilling effect. I think our bill elevated the conversation
here in the United States in school boards and State legislatures.
Because of this discussion, we now have 31 ``asthma-friendly''
States, such as my own State of Florida. Furthermore, of these 31, 19
extend their protection even further to anaphylaxis medication, like
epinephrine auto-injectors. On Asthma Awareness Day, May 7, 2003, when
we first started this, at that time there were only 20 States, and only
nine with this extra protection.
As mentioned earlier, over 6.3 million children under the age of 18
suffer from asthma, probably more than that when you realize a lot of
people do not even admit to having asthma. It is the most common cause
of missed school days, 14 million annually. It costs us tremendously in
lost time, learning, lost productivity and earnings of parents, and
medical expenses, including costly emergency room visits, not to
mention the enormous amount of stress for people involved, the parents
and children.
September 22, 2003, a Newsweek magazine article cover story, as you
will remember, said, ``Your Child's Health and Safety: The Latest on
Allergies and Asthma.'' ``The Allergy Epidemic'' pointed out, ``We have
conquered most childhood infections, but,'' and this is what is
important, ``extreme reactions to everyday substances still pose a new
threat.''
We read about David Adams of Georgia, whose acute allergic reaction
to peanuts was stanched by a quick epinephrine injection, ``never sets
foot outside his home without an emergency supply of epinephrine.''
This ``Fighting for Air'' article states, ``Asthma among children has
more than doubled over the past 20 years,'' and at Chicago's Hughes
Elementary School, ``at this school of 500 students, an astonishing
one-third have asthma.'' Second grader Zeron Moody ``just wants to play
without gasping'' for air.
When asthma attacks, every minute counts. Sadly, there have been
tragedies when a school child is prevented from swift access to his or
her asthma medication. A student who must go to the nurse's office,
even if there is a school nurse, to get his or her prescribed, life-
saving medication, just may run out of time for the initial treatment
that could save his or her life.
There is a 2002 article in a magazine called Reason entitled ``Asthma
Attack: When Zero Tolerance Collides with Children's Health.'' I just
want to share the horror of a 1991 death of a New Orleans high school
student, Catrina Lewis, who was simply delayed by security guards
before being allowed to get to her inhaler from the office. When
finally it did not help, she asked the school staff to call an
ambulance. Instead, they spent a half-hour trying to call her mother
first.
Catrina's sister, another student, finally called 911, but
unfortunately, tragically, the emergency help arrived too late.
Catrina's death resulted in more than heartbreak, but a legal judgment
against the principal, the counselor and school board. Obviously, in
this case no one comes out the winner.
Medical providers prescribe safe, legal treatment, along with
instructions on how to self-administer to patients diagnosed with
asthma and severe allergies. Along with parental support, it just makes
good medical sense to allow a student to treat him or herself and avoid
this possible tragedy in the classroom.
I would like to remind young people with asthma in this country that
throughout history there have been people we know or believe had
asthma, but they still accomplished great things; not because they had
asthma, but because they did not let it stop them from finding
greatness, achievement.
In the past 3 years, I have shared stories about President Theodore
Roosevelt and the Italian composer, priest and musician, Antonio
Vivaldi. In Congress, for Asthma Awareness Day we hosted famous
athletes who currently have and suffer from asthma. But, frankly, they
do not let it slow them down, and they still pursue their career:
Jerome Bettis of the Pittsburgh Steelers, who just last Sunday scored
two touchdowns, I say to my colleagues; and Jackie Joyner-Kersee,
Olympic heptathlete, most of us do not know what that is, but that is
an individual that competes in seven track and field events.
I would also like to point out another sober but timely point that
there may arise emergencies where a schoolchild with asthma simply,
simply needs to have his or her vital medication close at hand and not
locked in a desk drawer across the campus. We sadly just never know
these days when a homeland security event might call for a lockdown at
a school, for students to ``shelter in place.''
If this happens, that is why this bill is important. We want every
child to have his or her lifesaving medication on their person and not
in a shelter-in-place, in a lockdown position.
In conclusion, Mr. Speaker, H.R. 2023 is an important step for the
health of school children, for parental rights, and for trust in the
physician-patient-parent relationship and judgment.
{time} 1445
Again, I appreciate the support of my colleague, the gentleman from
Rhode Island (Mr. Kennedy), and I appreciate the gentleman from Texas
(Chairman Barton) for moving this bill, and the gentleman from Florida
(Chairman Bilirakis) for marking it up in the Subcommittee on Health.
We made great progress. We need the Senate to follow through, and we
need to pass this bill today, and I encourage its swift passage in the
Senate.
Mr. Speaker, I reserve the balance of my time.
Mr. BROWN of Ohio. Mr. Speaker, I yield 7 minutes to the gentleman
from Rhode Island (Mr. Kennedy), my friend.
Mr. KENNEDY of Rhode Island. Mr. Speaker, I rise today as the lead
Democratic cosponsor of the ASTHMA Act of 2003, and I want to
acknowledge my good friend and partner, the gentleman from Florida (Mr.
Stearns), for his excellent leadership on this matter. As my colleagues
have just heard him speak, he has spoken very eloquently to the case
that we are making through this legislation.
I think he illustrated better than anything else the reason why we
are pushing this legislation when he talked about the story of Catrina
Lewis. We in Rhode Island, and those stories are happening all over the
country; in Rhode Island, we have a family, the father, Walter Stone,
and the mother, Lynn Stone, lost their daughter, Morgan. She was a mild
asthmatic. She was attending college and was killed when her asthma
overcame her and she was not able to gain access to her medications.
This is a life-and-death issue. Unfortunately, many States have made
it a liability for those students to carry their inhalers to school
when those students need their medications. If
[[Page H8077]]
they have not registered them in the nurse's office, for example, they
are subject to all kinds of punishment. Then again, if they need their
medication, as those of us who have asthma, like myself, know very
well, it can come on you very quickly; and if you do not have your
medication available, you can have a much worse time of it. Tragically,
as we have seen in Catrina Lewis's case and in Morgan Stone's case, it
can be fatal.
The gentleman from Florida (Mr. Stearns), my good colleague, was
talking about the fact that we have 5,000 people die every year of
asthma. This is quite extraordinary when people consider that asthma
must not be that big a deal because when people suffer from asthma, it
does not look like they are suffering. That is the biggest impediment
for people in this country when approaching asthma, the fact that most
people, when seeing an asthmatic, do not see the suffering that an
asthmatic goes through when they are having an asthma attack, or do not
see the suffering that someone is going through when they have an
anaphylactic shock attack because of allergies to food.
Many times people do not take this seriously, and it is for just that
reason that we need to pass this legislation. It is because many school
districts do not take this seriously that we have had the situation
where too many young people have had to go through unspeakable
suffering as a result of an asthma attack that could have been treated,
or they have even suffered death because of the fact that they did not
have access to their medications. That is why we need to pass this
legislation.
We have heard eloquently from the gentleman from Florida (Mr.
Stearns) about the statistics. But the fact remains, with all of the
statistics, it is important that people keep in mind that asthma is the
single leading cause of missed school days in this country.
Unfortunately, more and more children suffering from asthma are
uninsured and do not have access to medications, so we also need to
talk about that. Unfortunately, that cannot be incorporated in this
legislation, but I know the gentleman from Florida (Mr. Stearns) and I
both will work hard to make sure that asthma medication is available to
our children who are not otherwise covered by health insurance. And the
reason for that is simple: Our children are making the emergency room
their primary source of medical care when they have asthma attacks and,
as any physician or parent can tell us, this is the worst kind of
health care policy we can have in this country.
We need to do more through the Centers for Disease Control to alert
families about asthma and to educate families about how to help them
manage their child's asthma if their children have asthma. These things
can make an enormous difference in a family's life, and certainly those
are also objectives that we need to follow as well.
Mr. Speaker, I know the gentleman from Florida (Mr. Stearns) and I
both owe a special debt of gratitude to Nancy Sanders, who is President
and founder of the Allergy and Asthma Network of Mothers of Asthmatics.
She has really encapsulated all of these issues through her advocacy,
and she speaks on behalf of all mothers of asthmatics when she
testifies as she does, and her partner in this effort, Marissa
Magnetti, who has also worked very hard to get this bill to the floor.
I want to thank both of them for their good work in getting this bill
to the floor.
Mr. Speaker, I want to thank once again my colleagues in the Congress
who have been helping us, the gentleman from Texas (Mr. Barton) for his
work in passing this in the committee; and of course, I want to thank
the gentleman from Florida (Mr. Stearns) for his good work and
partnership on this legislation.
Mr. STEARNS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I want to thank my colleague also for mentioning Nancy
Sanders, because I was going to save the best for last, Nancy Sanders,
the director of Mothers of Asthmatics, Allergy and Asthma Network;
without her energy and her time, we probably would not be here today.
So in large measure, this is a case where government is acting,
Congress is acting, but it is because of her and all her volunteers and
supporters have made this a major objective and mission for their
actions to try and bring to bear all of the resources of the private
sector so that we in the government are aware of this problem.
I know from some of the hearings that we have had, that both the
gentleman from Rhode Island (Mr. Kennedy) and I have shared, and we
have had many panels come out and speak, all of this was organized by
Nancy Sanders. So it is to her credit this bill is on the floor today,
because of her hard work.
So I appreciate the gentleman from Rhode Island (Mr. Kennedy)
bringing that to the attention of the floor, and I want to echo that,
how important it is to have Nancy Sanders.
Mr. KENNEDY of Rhode Island. Mr. Speaker, will the gentleman yield?
Mr. STEARNS. I yield to the gentleman from Rhode Island.
Mr. KENNEDY of Rhode Island. Mr. Speaker, I thank my colleague for
yielding.
She is working, as all of us are, on a number of these other agenda
items in helping to assist those who suffer from asthma and allergy
attacks. We have worked on more notification for families when
purchasing food products to know what is in those food products so that
they can be alerted to any food type that may trigger anaphylactic
shock. And I know that these and many other issues are ones that we are
going to need to continue to work for in the years ahead.
I thank my colleague for his effort on this and many others of these
issues.
Mr. STEARNS. Mr. Speaker, reclaiming my time, I would just give a
concluding remark. Not often when we come to the House floor do we have
legislation that will save lives. I had this experience when I was
working on the defibrillator bill, which the gentleman from Ohio (Mr.
Brown) is going to offer later on, which is another one of those bills
that will actually save lives. And this is one that will save lives,
not to mention the huge amount of stress that will be alleviated by
parents' knowing that their children will have their medication with
them at school.
Ms. JACKSON-LEE of Texas. Mr. Speaker, H.R. 2023, the Asthmatic
Schoolchildren's Treatment and Health Management Act of 2003, provides
incentives to States to help guarantee the rights of students to carry
and use prescribed lifesaving asthma and anaphylaxis medications while
at school.
Many students attend schools in States where State and/or local
statute prohibits them from carrying their prescribed asthma medication
on their person. Worse, anaphylaxis, including the loss of breathing,
can accompany a severe asthmatic attack. In an onset of asthma or an
anaphylactic attack, every minute counts, and a schoolchild who has to
go to a teacher's desk or school nurse's office to get his or her
asthma medication may not have sufficient time to initiate treatment.
I am pleased to be a cosponsor of this legislation, and just in the
past year and a half since we introduced H.R. 2023, many States are
passing laws protecting these students. We now have 31 States that
permit students to possess and self-administer asthma medication, such
as albuterol inhalers. Of these 31, 19 extend that protection even
further to include anaphylaxis medication, such as epinephrine auto-
injectors. A year and a half ago, there were only 20 States with
statutes that protected students to possess and self-administer
inhalers, and only 9 of those allowed permission for epinephrine auto-
injectors. Great progress has been made, and your vote for H.R. 2023
can only encourage further success.
In my State of Texas, approximately 900,000 adults, or 6 percent of
the population, currently have asthma. Children are particularly hard
hit in having asthma--which really can take away the joy of being a
child.
H.R. 2023 encourages states to pass asthma-friendly legislation,
without new spending, without mandates. This bill directs the Secretary
of Health and Human Services to give preference to a State's asthma and
anaphylaxis medication statutes when awarding grants for asthma-related
programs under its Department (such as Centers for Disease Control and
Prevention studies). It offers a gentle incentive for States to take
this easy, healthy step for its young citizens. My State of Texas could
greatly benefit from such an incentive, as we have a high asthma rate
and still do not guarantee the rights of children to carry their own
asthma medication.
Mr. ENGEL. Mr. Speaker, I rise in support of H.R. 2023, the Asthmatic
Schoolchildren's Treatment and Health Management Act of 2004. As a
cosponsor of this important legislation, I look forward to its quick
enactment. Asthma has had a tremendous impact on our
[[Page H8078]]
Nation's health. I represent the Bronx, Westchester and Rockland County
in New York, and our community has been hit very hard by asthma,
especially our children. My family has experienced first-hand the
effects of asthma. My wife has asthma and two of my kids do as well. So
I know how important it is that people, especially children, have
access to care and have the medicine they need when they need it.
According to the NYC Department of Health in the Bronx, about 25
percent of children in the Bronx have asthma, as opposed to 15 percent
nationwide. Hospitalization rates for children are around ten times
higher than the national average. The Bronx, in particular, leads New
York City in asthma-related hospitalizations and deaths. Audrey
Dregante, a Nurse Practitioner at Bronx Lebanon Hospital Pediatric
Asthma Center has stated that ``Pediatric Asthma is an epidemic in the
Bronx.''
There are many factors contributing to asthma that can easily be
addressed and would save lives and greatly enhance the quality of life
for so many suffering with asthma. Some of the factors contributing to
the disease are inadequate housing conditions, such as mold in homes,
dust mites and insects, and the lack of proper ventilation. The poor
are less likely to have health care and use emergency room care as
their primary care provider, and are not getting the proper treatment.
Low-birth weight babies are surviving in greater numbers and problems
with lung development may be leading to the rise in asthma cases. Early
diagnosis and treatment is critical in these instances, as well as pre-
natal care for the poor. The increasing amounts of pollution and
congestion in urban areas caused by traffic and diesel-powered trucks
and buses increase the risk for asthma.
Children in particular have a difficult time with asthma and, as we
know, proper treatment and control of the disease in crucial. the
legislation before us today seeks to rectify one situation that is
preventing children from even carrying their asthma medication.
Amazingly, many states do not allow kids to self-administer their
asthma medications in school, which can lead to severe conditions if
proper treatment is not available in time. New York does allow kids to
carry and administer their asthma medication. I believe it is
irrational and irresponsible to prohibit children from having their
medication readily available. H.R. 2023 would encourage schools to
allow children to carry their asthma medication by giving those schools
preference when awarding public health and asthma-related grants. I
think this is positive legislation that will encourage school districts
to allow their children to carry and self-administer their asthma
medicine, which will improve their condition and could save their
lives. I urge my colleagues to support this legislation.
Mr. DAVIS of Illinois. Mr. Speaker, I rise today in support of H.R.
2023, the Asthmatic Schoolchildren's Treatment and Health Management
Act. Nearly one-third of all people with asthma in our Nation are
children under the age of 18, according to the American Lung
Association. This figure translates to more than 6.3 million children.
Asthma is now the most common, serious, chronic disease among children,
accounting for 14 million absences from school each year.
I commend this legislation and believe it is great to allow students
to self-administer medication to treat that student's asthma. We are
encouraging the child to control their condition with correct
management of it as well as giving them the responsibility to go get
their nebulizer for a breathing treatment or get their inhaler when
they know they need it. However, we still need to do more for our
asthmatic children through education and outreach. Doctors say that
asthma is a disease that can be managed, treated and prevented. Yet
across our country, in cities like Chicago, there are no centralized
asthma programs, and many States do not keep an up-to-date count of how
many children have the disease.
We have seen asthma continue to strike black children the hardest,
especially those who live in low-income areas. The 2002 National Health
Interview Survey, a project of the CDC, found that 12 percent of all
children under age 18 were asthmatic, and half had suffered an attack
in the previous year. Black and low-income families get it far more
often: 18 percent of black children had been diagnosed with asthma, and
9 percent had suffered attacks, versus 10 and 4 percent for Latino
children, and 11 and 5 percent for whites. Due to a lack of health
care, crowded housing, and more exposure to asthma triggers such as
cockroach feces and dust mites, the asthma rate was also higher for
children from families whose incomes were less than $20,000 a year.
Although, most children have mild to moderate problems, and their
illness can be controlled by treatment at home, too many of our
asthmatic children are ending up in our emergency rooms. The CDC
reports that in 1999, 658,000 pediatric emergency room visits were due
to asthma. The estimated annual rate for emergency room visits among
children 5 years old or younger is 137.1 per 10,000 persons--the
highest rate of all age groups. Asthma cost more than $4.6 billion in
medical care and time lost from school or work. African Americans have
nearly four times the asthma related emergency room visits as whites
and are more than three times as likely than whites to be hospitalized
for asthma.
Mr. Speaker, unfortunately, Chicago, where I reside, is commonly
called an epicenter of the Nation's asthma epidemic. I believe that my
State of Illinois, Chicago and our Congress need to encourage that more
is done to help our asthmatic children, like education and, as the
doctors suggest, managing, treating and prevention of this disease as a
way to keep more of our kids out of the emergency rooms.
Mrs. CHRISTENSEN. Mr. Speaker, I rise today to join my colleague
Congressman Cliff Stearns of Florida in the passage of H.R. 2023, the
Asthmatic Schoolchildren's Treatment and Health Management Act of 2004.
Mr. Speaker, as a medical doctor I know of nothing more important to a
patient than the ability to access his/her medication. The bill before
us today underscores this critical component in the continuum of care
as it relates to asthma and school-age children.
I am grateful to Mr. Stearns for introducing this important piece of
legislation and will be working forward to its impact in African
American and medically underserved communities. As you know, Mr.
Speaker, asthma is the 6th-ranking chronic condition in the U.S., and
the leading serious chronic illness of children in the U.S., and has a
significant impact on African Americans. Not only do African Americans
have a higher asthma prevalence rate than Caucasians, but they are also
more likely to be hospitalized or die due to asthma.
Data released in 2003 by the Centers for Disease Control and
Prevention stated that the lifetime prevalence rate is 29 percent
higher in African Americans than in Caucasians. The asthma attack
prevalence rate in African Americans is 37 percent higher than in
Caucasians, and the asthma attack prevalence rates in African-Americans
are highest among children under the age of 5.
The CDC also noted that African Americans have nearly four times the
asthma-related emergency room visits than Caucasians and that African
Americans are more than three times more likely than Caucasians to be
hospitalized for asthma. Finally, African Americans are three times
more likely than Caucasians to die from asthma and more African
American women die from asthma than any other group.
A recent study by Guido R. Zanni and Jeannette Wick, entitled
Counseling Inner-City Youth with Asthma, found that approximately 1 in
13 school-age children is affected--an increase of 72.3 percent since
the 1980s. Asthma-related absenteeism amounted to 14 million missed
school days in 2000.
The researchers noted that the inner cities have unique challenges
with asthma-causing agents: Tobacco and cooking smoke, indoor
allergens, bioaerosols and other air pollutants, respiratory
infections, and stress. Up to 59 percent of inner-city pediatric asthma
sufferers live in homes with environmental tobacco smoke. Sensitivity
to allergens is typical of pediatric asthma. Most inner-city children
(94 percent are highly sensitive to inhalant allergens, and 76 percent
are sensitive to 3 or more allergens. Approximately 36 percent have
cockroach sensitization. Combining cockroach sensitization with regular
exposure significantly increases asthma-related hospitalizations,
emergency room visits, school absenteeism, and lost sleep.
The researchers noted some of the causes of nonadherence to asthma
medication regimens by school-age children are created by parental
health beliefs, the use of multiple care providers, the lack of a
comprehensive asthma-management plan, psychosocial stressors,
inadequate attention to triggers and early warning signals, and
inadequate environmental allergen control. They also noted that many
schools have a zero-tolerance drug policy, forcing students to smuggle
and take their asthma medications discreetly or leave their medications
at home.
Mr. Speaker, I believe that H.R. 2023 is a step in the right
direction towards eliminating health disparities by making grants
available to States, with a preference to States that require public
elementary and secondary schools to allow students to self-administer
medication to treat that student's asthma or anaphylaxis under
specified conditions.
Again, Mr. Speaker, I believe that this bill is a measure that
safeguards the health of children with asthma and urge my colleagues to
support it.
Mr. ENGEL. Mr. Speaker, asthma has had a tremendous impact on our
Nation's health. I
[[Page H8079]]
represent the Bronx, Westchester and Rockland County in New York, and
we have been hit very hard by asthma, especially our children.
According to the NYC Department of Health, in the Bronx about 25
percent of children have asthma, as opposed to 15 percent Nationwide;
hospitalization rates for children are around ten times higher than the
national average; and the Bronx, in particular, leads New York City in
asthma-related hospitalizations and deaths. Audrey Dregante, a nurse
practitioner at Bronx Lebanon Hospital, Pediatric Asthma Center has
stated that ``Pediatric Asthma is an epidemic in the Bronx.''
There are many factors contributing to asthma that can easily be
addressed and would save lives and greatly enhance the quality of life
for so many suffering with asthma. Many of these factors have to do
with the economic status of those with asthma and the fact that they
are not educated on the treatments available. Some of the factors
contributing to the disease are inadequate housing conditions--
impoverished conditions such as mold in homes, dust mites and insects,
and the lack of proper ventilation; the poor are less likely to have
health care and use emergency room care as their primary care provider
and are not getting the proper treatment; low-birth weight babies are
surviving in greater numbers, and problems with lung development may be
leading to the rise in asthma cases--early diagnosis and treatment is
critical in these instances, as well as pre-natal care for the poor;
and the increasing amounts of pollution and congestion in urban areas
caused by traffic and diesel-powered trucks and buses.
Children in particular have a difficult time with asthma and, as we
know, proper treatment and control of the disease is crucial. The
legislation before us today seeks to rectify one situation that is
preventing children from even carrying their asthma medication.
Amazingly, many States do not allow kids to self-administer their
asthma medications in school, which can lead to severe conditions if
proper treatment is not available in time.
New York does allow kids to carry and administer their asthma
medication. I believe it is irrational and irresponsible to prohibit
children from having their medication readily available. H.R. 2023
would encourage schools to allow children to carry their asthma
medication by giving those schools preference when awarding public
health and asthma-related grants.
I think this is positive legislation that will encourage school
districts to allow their children to carry and self-administer their
asthma medicine, which will improve their condition and could save
their lives. I urge my colleagues to support this legislation.
Mr. STEARNS. Mr. Speaker, I yield back the balance of my time.
Mr. BROWN of Ohio. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Fossella). The question is on the motion
offered by the gentleman from Texas (Mr. Barton) that the House suspend
the rules and pass the bill, H.R. 2023, as amended.
The question was taken; and (two-thirds having voted in favor
thereof) the rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.
____________________