by Maureen Anichini Lemon (Winter 2017)

In August 2016, Governor Rauner signed legislation to augment Illinois schools’ efforts to manage student asthma. Section 22-30 of the Illinois School Code already allowed students to carry and administer asthma medication, as well as epinephrine auto-injectors, under certain conditions (105 ILCS 5/22-30). It also authorizes, but does not require, school districts to supply an opioid antagonist to be used by a school nurse or trained personnel in the event of an opioid overdose.

Public Act 99-0843 added three new provisions to Section 22-30 to address the needs of students with asthma. Section 22-30 (j-5) requires school districts to annually request families to share with the school an asthma action plan developed with the student’s medical provider. Section 22-30 (j-10) requires school districts to have adopted an asthma episode emergency response protocol by January 1, 2017. Section 22-30 (j-15) requires school districts to train school personnel regarding asthma every two years.

An “asthma action plan” is a written plan developed with a student’s medical provider to control the student’s asthma. The plan’s goal is to reduce or prevent flare-ups and emergency room visits through day-to-day management of a student’s asthma. A sample Asthma Action Plan form is now available on the Illinois State Board of Education (ISBE) website. If a family shares an asthma action plan with the school, the plan must be kept in the office of the school nurse or school administrator. The school may distribute copies of the plan to appropriate school staff who interact with the student on a regular basis, and may be attached to the student’s Section 504 plan or IEP.

The protocol required to be adopted by each school district explains the procedure to assist a student experiencing symptoms of wheezing, coughing, shortness of breath, chest tightness, or breathing difficulty. ISBE unveiled the model “Illinois Asthma Episode Emergency Response Protocol” in October 2016. The document was prepared by the ISBE in collaboration with several organizations with expertise in asthma management, including the American Lung Association.  A copy of the model protocol may be found at https://www.isbe.net/Documents/asthma_response_protocol.pdf.

Each school board’s adopted protocol must include every component of ISBE’s model protocol. All staff members should be familiar with the protocol. Additionally, any staff member likely to assist a student with asthma should review the protocol AND practice how to use the student’s prescribed quick-relief inhaler with a “trainer”. The model protocol defines a “trainer” as a registered nurse assigned to the school, if available, or a review of the package insert of the student’s quick-relief inhaler medication.

Finally, the biennial training of school staff who work with students may be in-person or online, and should focus on the management of asthma, the prevention of asthma symptoms, and emergency response in the school setting. ISBE’s website indicates that it will post training resources in the near future.

The importance of training staff members and appropriately following the asthma episode emergency response protocol was underscored by the recent Illinois appellate court decision, In re Estate of Jeffrey Stewart, 2016 IL App (2d) 151117. In Stewart, an 18-year old student collapsed during a high school English class. The teacher immediately ran to Stewart’s side and, not knowing what was wrong, told two students to get the nurse. Once the nurse arrived and assessed the situation, 911 was called. The student subsequently died and the autopsy report stated that he had died from an asthma attack. Stewart’s mother filed a lawsuit against the school district and English teacher, claiming that the teacher acted willfully and wantonly in responding to Stewart’s collapse, and that the school district had not properly trained the teacher. The trial court and appellate court agreed, concluding that the teacher violated a clear policy to “call or have someone call 911 immediately under life and death circumstances.”

The courts rejected the teacher’s reliance on the nurse to make that determination because the teacher didn’t know that it was a life and death situation. They also found lacking the teacher’s training and awareness of the student’s asthma.

While Public Act 99-0843 may not have been a legislative response to the Stewart decision, that decision is a reminder of the importance of training all school personnel regarding asthma management and emergency response. If you have any questions regarding the obligations described in this article, please contact Maureen Lemon.