H.B. No. 1849
  relating to the possession and administration of epinephrine
  auto-injectors in day-care centers; limiting liability.
         SECTION 1.  Subchapter C, Chapter 42, Human Resources Code,
  is amended by adding Section 42.067 to read as follows:
  LIABILITY.  (a)  In this section:
               (1)  "Anaphylaxis" means a sudden, severe, and
  potentially life-threatening allergic reaction that occurs when a
  person is exposed to an allergen.
               (2)  "Epinephrine auto-injector" means a disposable
  medical drug delivery device that contains a premeasured single
  dose of epinephrine intended for use to treat anaphylaxis.
               (3)  "Physician" means a person who holds a license to
  practice medicine in this state.
         (b)  A physician, or a person who has been delegated
  prescriptive authority under Chapter 157, Occupations Code, may
  prescribe epinephrine auto-injectors in the name of a day-care
         (c)  A physician or other person who prescribes epinephrine
  auto-injectors under Subsection (b) shall provide the day-care
  center with a standing order for the administration of an
  epinephrine auto-injector to a person reasonably believed to be
  experiencing anaphylaxis.
         (d)  A standing order under Subsection (c) is not required to
  be patient-specific.  An epinephrine auto-injector may be
  administered under this section to a person without a previously
  established physician-patient relationship.
         (e)  Notwithstanding any other law, supervision or
  delegation by a physician is considered adequate if the physician:
               (1)  periodically reviews the order; and
               (2)  is available through direct telecommunication as
  needed for consultation, assistance, and direction.
         (f)  An order issued under this section must contain:
               (1)  the name and signature of the prescribing
  physician or other person;
               (2)  the name of the day-care center to which the order
  is issued;
               (3)  the quantity of epinephrine auto-injectors to be
  obtained and maintained under the order; and
               (4)  the date the order was issued.
         (g)  A pharmacist may dispense an epinephrine auto-injector
  to a day-care center without requiring the name of or any other
  identifying information relating to the user.
         (h)  A day-care center shall store an epinephrine
  auto-injector in a secure location that is easily accessible to
  employees or volunteers of the day-care center authorized and
  trained to administer an epinephrine auto-injector.
         (i)  Each day-care center is responsible for training
  employees in the administration of an epinephrine auto-injector.  
  The training must:
               (1)  include information on:
                     (A)  recognizing the signs and symptoms of
                     (B)  administering an epinephrine auto-injector;
                     (C)  the recommended dosages for adults and
  children by age and weight, if applicable, and the dosages
  available at the center;
                     (D)  implementing emergency procedures, if
  necessary, after administering an epinephrine auto-injector; and
                     (E)  the proper disposal of used or expired
  epinephrine auto-injectors; and
               (2)  be completed annually in a formal training session
  or through online education.
         (j)  Each day-care center shall maintain records on the
  training required under this section.
         (k)  Not later than the 10th business day after the date a
  day-care center employee administers an epinephrine auto-injector
  in accordance with this section, the day-care center shall report
  the following information to the persons listed in Subsection (l):
               (1)  the age of the person who received the
  administration of the epinephrine auto-injector;
               (2)  whether the person who received the administration
  of the epinephrine auto-injector was:
                     (A)  a child enrolled in the day-care center;
                     (B)  a day-care center employee or volunteer; or
                     (C)  a visitor to the day-care center;
               (3)  the physical location where the epinephrine
  auto-injector was administered;
               (4)  the number of doses of epinephrine auto-injector
               (5)  the title of the employee who administered the
  epinephrine auto-injector; and
               (6)  any other information required by the executive
         (l)  The information required by Subsection (k) shall be
  reported to:
               (1)  the owner of the day-care center;
               (2)  the physician or other person who prescribed the
  epinephrine auto-injector;
               (3)  the commission; and
               (4)  the Department of State Health Services.
         (m)  The executive commissioner, in consultation with the
  Department of State Health Services, shall adopt rules necessary to
  implement this section.
         (n)  A person who in good faith takes, or fails to take,
  action relating to the prescription of an epinephrine auto-injector
  to a day-care center or the administration of an epinephrine
  auto-injector in a day-care center is immune from civil or criminal
  liability or disciplinary action resulting from that action or
  failure to act, including:
               (1)  issuing an order for epinephrine auto-injectors;
               (2)  supervising or delegating the administration of an
  epinephrine auto-injector;
               (3)  possessing, maintaining, storing, or disposing of
  an epinephrine auto-injector;
               (4)  prescribing an epinephrine auto-injector;
               (5)  dispensing an epinephrine auto-injector;
               (6)  administering, or assisting in administering, an
  epinephrine auto-injector;
               (7)  providing, or assisting in providing, training,
  consultation, or advice in the development, adoption, or
  implementation of policies, guidelines, rules, or plans; or
               (8)  undertaking any other act permitted or required
  under this section.
         (o)  The immunities and protections provided by this section
  are in addition to other immunities or limitations of liability
  provided by law.
         (p)  Notwithstanding any other law, this section does not
  create a civil, criminal, or administrative cause of action or
  liability or create a standard of care, obligation, or duty that
  provides a basis for a cause of action for an act or omission under
  this section.
         (q)  If a day-care center obtains epinephrine auto-injectors
  for use as authorized by this section, the day-care center shall
  notify each parent of a child enrolled in the center of the center's
  policy and procedures relating to the administration of the
  epinephrine auto-injectors.
         (r)  An act or omission described by this section does not
  create a cause of action.
         SECTION 2.  This Act takes effect immediately if it receives
  a vote of two-thirds of all the members elected to each house, as
  provided by Section 39, Article III, Texas Constitution.  If this
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect September 1, 2019.
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
         I certify that H.B. No. 1849 was passed by the House on April
  2, 2019, by the following vote:  Yeas 147, Nays 0, 1 present, not
  Chief Clerk of the House   
         I certify that H.B. No. 1849 was passed by the Senate on May
  22, 2019, by the following vote:  Yeas 31, Nays 0.
  Secretary of the Senate    
  APPROVED:  _____________________