Asthmatic Schoolchildren's Treatment and Health Management Act of 2004

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.

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. 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.

I yield to the gentleman from Rhode Island.

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.

Mr. Speaker, I yield back the balance of my time.

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

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. Speaker, asthma has had a tremendous impact on our Nation's health. I

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. 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

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. Speaker, will the gentleman yield?

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. 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. 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.