[House Report 108-121]
[From the U.S. Government Publishing Office]
108th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 108-121
======================================================================
CHILD MEDICATION SAFETY ACT OF 2003
_______
May 21, 2003.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Boehner, from the Committee on Education and the Workforce,
submitted the following
R E P O R T
[To accompany H.R. 1170]
[Including cost estimate of the Congressional Budget Office]
The Committee on Education and the Workforce, to whom was
referred the bill (H.R. 1170) to protect children and their
parents from being coerced into administering psychotropic
medication in order to attend school, and for other purposes,
having considered the same, report favorably thereon with an
amendment and recommend that the bill as amended do pass.
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Child Medication Safety Act of
2003''.
SEC. 2. REQUIRED POLICIES AND PROCEDURES.
(a) In General.--As a condition of receiving funds under any program
or activity administered by the Secretary of Education, not later than
1 year after the date of the enactment of this Act, each State shall
develop and implement policies and procedures prohibiting school
personnel from requiring a child to obtain a prescription for
substances covered by section 202(c) of the Controlled Substances Act
(21 U.S.C. 812(c)) as a condition of attending school or receiving
services.
(b) Rule of Construction.--Nothing in subsection (a) shall be
construed to create a Federal prohibition against teachers and other
school personnel consulting or sharing classroom-based observations
with parents or guardians regarding a student's academic performance or
behavior in the classroom or school, or regarding the need for
evaluation for special education or related services under section
612(a)(3) of the Individuals with Disabilities Education Act (20 U.S.C.
1412(a)(3)).
SEC. 3. DEFINITIONS.
In this Act:
(1) Child.--The term ``child'' means any person within the
age limits for which the State provides free public education.
(2) State.--The term ``State'' means each of the 50 States,
the District of Columbia, and the Commonwealth of Puerto Rico.
SEC. 4. GAO STUDY AND REVIEW.
(a) Review.--The Comptroller General of the United States shall
conduct a review of--
(1) the variation among States in definitions of psychotropic
medication as used in regard to State jurisdiction over public
education;
(2) the prescription rates of medications used in public
schools to treat children diagnosed with attention deficit
disorder, attention deficit hyperactivity disorder, and other
disorders or illnesses;
(3) which medications used to treat such children in public
schools are listed under the Controlled Substances Act; and
(4) which medications used to treat such children in public
schools are not listed under the Controlled Substances Act,
including the properties and effects of any such medications
and whether such medications have been considered for listing
under the Controlled Substances Act.
(b) Report.--Not later than 1 year after the date of enactment of
this Act, the Comptroller General of the United States shall prepare
and submit a report that contains the results of the review under
subsection (a).
PURPOSE
H.R. 1170, the Child Medication Safety Act of 2003,
addresses the significant concern that parents are being
required to obtain a prescription for psychotropic medication
for their child in order for the child to attend school or
receive services. The bill protects parents from being forced
by school personnel into medicating their child's under duress.
COMMITTEE ACTION
Subcommittee hearing
On Tuesday, May 6, 2003, the Committee on Education and the
Workforce, Subcommittee on Education Reform, held a hearing in
Washington, D.C. on ``Protecting Children: The Use of
Medication in Our Nation's Schools and H.R. 1170, the Child
Medication Safety Act of 2003''. The purpose of this hearing
was to gather information exploring the prevalence of children
diagnosed with Attention Deficit Hyperactivity Disorder (ADHD)
and Attention Deficit Disorder (ADD), the appropriate role of
prescription medication, and the concern that some school
officials are coercing parents to place their child on a
prescription for psychotropic medication in order to attend
school. Testifying before the Subcommittee were the Honorable
Katherine Bryson, State Representative in the Utah House of
Representatives from Orem, Utah; Dr. William Carey, MD,
Director of Behavioral Pediatrics at The Children's Hospital of
Philadelphia, Philadelphia, PA; and Dr. Lance Clawson, MD,
Private Psychiatrist from Cabin John, Maryland.
Legislative action
On March 11, 2003, Representative Max Burns (R-GA)
introduced H.R. 1170, the Child Medication Safety Act. This
legislation would require States receiving federal education
funds to set up policies and procedures prohibiting school
personnel from requiring children to take drugs listed on
Schedule II of the Controlled Substances Act in order to attend
school or receive services.
On May 15, 2003, the Committee on Education and the
Workforce considered H.R. 1170 in legislative session and
reported it favorably, as amended, to the House of
Representatives, by voice vote. The Committee considered three
amendments and adopted the following two amendments.
The Committee adopted by voice vote an amendment in the
nature of a substitute offered by Mr. Burns. The substitute
expands the list of drugs covered by the bill to include all
drugs covered under the Controlled Substances Act. The
substitute also added a provision that allowsschool personnel
to consult with parents regarding classroom-based observations about
the child's academic performance and behavior in the classroom while
confirming that teachers and other school personnel continue to be able
to refer children for evaluation as provided under the Individuals with
Disabilities Education Act.
The Committee adopted by voice vote an amendment offered by
Mrs. Musgrave requiring a GAO study to examine the use of
psychotropic medication in schools and to report on whether
such medications are listed under the Controlled Substances Act
and the effect of non-scheduled medications. The study will
provide a current review of all definitions States are using
for psychotropic medications, what medications are being used
in schools, and the prevalence of their use.
SUMMARY
H.R. 1170, the Child Medication Safety Act, requires States
that receive any federal education funds to develop and
implement policies and procedures that would prohibit school
personnel from requiring a child to obtain a prescription for a
controlled substance in order to attend school.
COMMITTEE VIEWS
The Child Medication Safety Act of 2003 requires States, as
a condition of receiving Federal education funds, to establish
policies and procedures prohibiting school personnel from
requiring a child to take medication in order to attend school.
Only medical personnel have the ability to determine if a
prescription for a psychotropic drug is appropriate for a
child.
Testifying before the Subcommittee on Education Reform on
May 6, 2003, Dr. William Carey stated that:
In the last two decades the United States has
experienced a great increase in the diagnosis of
Attention Deficit Hyperactivity Disorder (ADHD) and its
treatment with stimulants. Not only child health
professionals but now also a wide variety of
unqualified persons, such as preschool teachers and
acquaintances, are freely offering the diagnosis and
confidently urging parents to accept their judgment and
obtain drug treatment, such as methylphenidate
(Ritalin), for the child. . . . This chaotic situation
urgently requires intervention at several levels,
including the Federal government.
The Committee has been made aware of situations where
parents have voiced concern that local educational agency
officials have required them to place children on psychotropic
medication in order to attend school or receive services. The
Committee feels that school officials should not presume to
know what medication a child needs, or if the child even needs
medication. Representative Katherine Bryson testified to the
Subcommittee on Education Reform that:
[S]chool personnel faced with children who often have
not been properly taught to read, who may be coming to
school on a breakfast of sugar or no breakfast at all,
who could be affected by lead, mercury or other toxic
substances--a plethora of explainable reasons--are
assessing them in the classroom as having a ``learning
disorder'' or Attention Deficit Hyperactivity Disorder
(ADHD). From here, parents are being coerced into
drugging their child with threats of the child's
expulsion or charges of medical neglect by Child
Protective Services against the parents who refuse to
give or take their child off a psychiatric drug.
The Committee believes that only medical personnel have the
ability to determine if a prescription for a psychotropic drug
is appropriate for a child or if medication is appropriate at
all.
Accordingly the bill requires States, as a condition of
receiving any Federal education funds, to establish policies
and procedures prohibiting school personnel from requiring a
parent to obtain a prescription for their child for drugs
listed under the Controlled Substances Act in order to attend
school or receive services. The Controlled Substances Act
regulates the manufacture and distribution of narcotics,
stimulants, depressants, hallucinogens, anabolic steroids, and
chemicals used in the illicit production of controlled
substances. The Controlled Substances Act places all regulated
substances into one of five schedules. This placement is based
upon a substance's medicinal value, harmfulness, and potential
for abuse or addiction. Ritalin is listed on Schedule II of the
Controlled Substances Act, and drugs are placed on that
Schedule when: (A) The drug or other substance has a high
potential for abuse; (B) The drug or other substance has a
currently accepted medical use in treatment in the United
States or a currently accepted medical use with severe
restrictions; or (C) Abuse of the drug or other substances may
lead to severe psychological or physical dependence.
Psychotropic drugs, such as Ritalin, can be beneficial to
some individuals when properly diagnosed and the medication is
properly administered and monitored. In testifying to the
Subcommittee on Education Reform, Dr. Lawrence Clawson stated
``research clearly demonstrates that medication can be an
effective part of treatment for ADHD.'' The Committee
recognizes the validity of that research, but is concerned that
too often the easy answer of medication is utilized as a
response for too many children. As Dr. Carey noted, treatment
is improved by educational as well as medical interventions.
The Committee also wants to stress the importance of open
and effective communication between the parent and school
officials (including teachers) regarding the needs of the child
as a whole. In no way does the Committee intend for this
legislation to stifle appropriate conversation between school
officials and parents about the behavior and academic
achievement of the child. School personnel spend many hours a
day with a child and are able to observe a variety of
situations and behaviors. When parents seek to discuss their
child with a teacher or school official, school personnel
should continue to be free to discuss their observations with
the parent to ensure that the parent has sufficient information
to make appropriate decisions about their child's medical
needs. However, the Committee cautions that such discussion
should be mutual consulting conversations that describe and
identify areas of concern, but which are not followed by
recommendations of school personnel that would be construed as
a medical diagnosis or condition of attending school.
The Committee has heard from many parents, teachers, and
national organizations that feel that there must continue to be
open lines of communication between school personnel and
parents about the academic, behavioral, and health related
needs of children. The Committee shares the concern of those
organizations, but feels that this legislation walks a clear
and carefully crafted line of ensuring that such communication
can take place, while protecting parents from being coerced by
school officials to place their child on a psychotropic drug in
order for the child to attend school or receive services.
The Committee recognizes that there is a need for greater
information on this topic, and includes in the bill a
requirement that the GAO issue a report examining the use of
psychotropic medication in schools and to report on whether
such medications are listed under the Controlled Substances Act
and the effect of any non-scheduled medications. The study will
provide a current review of all definitions States are using
for psychotropic medications, what medications are being used
in schools, and the prevalence of their use.
This is an important study that will help provide greater
information to Congress and State and local educational
agencies, as well as medical professionals, to improve the
understanding of the types of medications that exist to treat
children with attention deficit disorder, attention deficit-
hyperactivity disorder, and other disorders or illnesses.
Summary
In recent decades, there has been a growing number of
children diagnosed with attention deficit disorder (ADD) or
attention deficit-hyperactivity disorder (ADHD) and then
treated with medications such as Ritalin or Adderall. In many
of these cases, school personnel freely offer diagnoses for
these disorders and urge parents to obtain drug treatment for
the child. Sometimes officials attempt to force parents into
medicating their child in order for the child to continue going
to school.
H.R. 1170 aims to remedy this significant problem. The goal
of this Act is straightforward. It would require States to
establish policies and procedures prohibiting school personnel
from requiring a child to take medication in order to attend
school. At the same time, this bill carefully preserves the
teacher-parent communication that is essential to fostering
strong academic achievement for children. The Committee
believes that this bill takes important steps to protect
children, and their parents, and sets up a good standard for
States to follow.
SECTION-BY-SECTION ANALYSIS
Section 1. Short Title. Establishes the short title of the
act to be the ``Child Medication Safety Act of 2003.''
Section 2. Required Policies and Procedures. Establishes
required policies and procedures prohibiting the requirement of
a prescription, and includes a rule of construction regarding
consulting on classroom-based observations.
Section 3. Definitions. Establishes definitions for the
terms ``child'' and ``state.''
Section 4. GAO Study and Review. Requires the Comptroller
General of the United States to review definitions and usage of
psychotropic medications.
EXPLANATION OF AMENDMENTS
The Amendment in the Nature of a Substitute is explained in
the body of this report.
APPLICATION OF LAW TO THE LEGISLATIVE BRANCH
Section 102(b)(3) of Public Law 104-1 requires a
description of the application of this bill to the legislative
branch. H.R. 1170, the Child Medication Safety Act, requires
States that receive any federal education funds to develop and
implement policies and procedures that would prohibit school
personnel from requiring a child to obtain a prescription for a
controlled substance in order to attend school. The bill does
not prevent legislative branch employees coverage under this
legislation.
UNFUNDED MANDATE STATEMENT
Section 423 of the Congressional Budget and Impoundment
Control Act (as amended by Section 101(a)(2) of the Unfunded
Mandates Reform Act, P.L. 104-4) requires a statement of
whether the provisions of the reported bill include unfunded
mandates. H.R. 1170 requires States that receive any federal
education funds to develop and implement policies and
procedures that would prohibit school personnel from requiring
a child to obtain a prescription for a controlled substance in
order to attend school. As such, the bill does not contain any
unfunded mandates.
CORRESPONDENCE
House of Representatives,
Committee on Education and the Workforce,
Washington, DC, May 20, 2003.
Hon. W.J. (Billy) Tauzin,
Chairman, Committee on Energy and Commerce,
Rayburn HOB, Washington, DC.
Dear Chairman Tauzin: I thank you for your May 20, 2003
letter, regarding H.R. 1170, the ``Child Medication Safety Act
of 2003'', which was referred to the Committee on Education and
the Workforce. The Education and the Workforce Committee
ordered the bill favorably reported on May 15, 2003. I intend
to file the report this week. I thank you for working with me
regarding an amendment adopted in Committee, offered by Rep.
Musgrave, which creates a new Section 4, GAO Study and Review,
and requires the General Accounting Office to study various
aspects of students on medication in our nation's schools.
While the Energy and Commerce Committee holds a jurisdictional
interest in Section 4, I appreciate your willingness to work
with me in moving H.R. 1170 forward without the need for
additional legislative consideration by your Committee.
I agree that this procedural route should not be construed
to prejudice the jurisdictional interest and prerogatives of
the Committee on Energy and Commerce over these provisions or
any other similar legislation and will not be considered as
precedent for consideration of matters of jurisdictional
interest to your Committee in the future.
I thank you for working with me regarding this matter and
look forward to continuing our work and cooperation on this
bill and similar legislation. This letter and your response
will be included in the Committee Report to accompany this
bill. If you have questions regarding this matter, please do
not hesitate to call me.
Sincerely,
John A. Boehner,
Chairman.
------
House of Representatives,
Committee on Energy and Commerce,
Washington, DC, May 20, 2003.
Hon. John A. Boehner,
Chairman, Committee on Education and the Workforce,
Rayburn House Office Building, Washington, DC.
Dear Chairman Boehner: On May 15, 2003, the Committee on
Education and the Workforce ordered reported H.R. 1170, the
Child Medication Safety Act of 2003. As ordered reported by
your Committee, the legislation contains a requirement for a
General Accounting Office study that falls within the
jurisdiction of the Committee on Energy and Commerce.
Recognizing your interest in bringing this legislation
before the House expeditiously, the Committee on Energy and
Commerce agrees not to seek a sequential referral of the bill.
By agreeing not to seek a sequential referral, the Committee on
Energy and Commerce does not waive its jurisdiction over these
provisions or any other provisions of the bill that may fall
within its jurisdiction. In addition, the Committee on Energy
and Commerce reserves its right to seek conferees on any
provisions within its jurisdiction which are considered in the
House-Senate conference, and asks for your support in being
accorded such conferees.
I request that you include this letter as part of the
report on H.R. 1170 and as part of the Congressional Record
during consideration of this bill by the House.
Sincerely,
W.J. ``Billy'' Tauzin,
Chairman.
STATEMENT OF OVERSIGHT FINDINGS AND RECOMMENDATIONS OF THE COMMITTEE
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the body of this report.
NEW BUDGET AUTHORITY AND CONGRESSIONAL BUDGET OFFICE COST ESTIMATE
With respect to the requirements of clause 3(c)(2) of rule
XIII of the House of Representatives and section 308(a) of the
Congressional Budget Act of 1974 and with respect to
requirements of 3(c)(3) of rule XIII of the House of
Representatives and section 402 of the Congressional Budget Act
of 1974, the Committee has received the following cost estimate
for H.R. 1170 from the Director of the Congressional Budget
Office:
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 16, 2003.
Hon. John A. Boehner,
Chairman, Committee on Education and the Workforce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1170, the Child
Medication Safety Act of 2003.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Donna Wong.
Sincerely,
Barry B. Anderson
(For Douglas Holtz-Eakin, Director).
Enclosure.
H.R. 1170--Child Medication Safety Act of 2003
H.R. 1170 would require states, as a condition of receiving
funds, to develop and implement policies and procedures
prohibiting school personnel from requiring a child to receive
or take controlled substances as a condition of attending
school or receiving services.
The bill would result in no significant cost to the federal
government and would not affect direct spending or receipts.
The bill contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would impose no costs on state, local, or tribal governments.
The CBO staff contact for this estimate is Donna Wong. This
estimate was approved by Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis.
STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
In accordance with clause (3)(c) of House rule XIII, the
goal of H.R. 1170 is to require States that receive any federal
education funds to develop and implement policies and
procedures that would prohibit school personnel from requiring
a child to obtain a prescription for a controlled substance in
order to attend school. The Committee expects the Department of
Education to comply with H.R. 1170 and implement the changes to
the law in accordance with the changes.
CONSTITUTIONAL AUTHORITY STATEMENT
Under clause 3(d)(1) of rule XIII of the Rules of the House
of Representatives, the Committee must include a statement
citing the specific powers granted to Congress in the
Constitution to enact the law proposed by H.R. 1170. The
Committee believes that the amendments made by this bill, which
authorize appropriations for education assistance, are within
Congress' authority under Article I, section 8, clause 1 of the
Constitution.
COMMITTEE ESTIMATE
Clause 3(d)(2) of rule XIII of the Rules of the House of
Representatives requires an estimate and a comparison by the
Committee of the costs that would be incurred in carrying out
H.R. 1170. However, clause 3(d)(3)(B) of that rule provides
that this requirement does not apply when the Committee has
included in its report a timely submitted cost estimate of the
bill prepared by the Director of the Congressional Budget
Office under section 402 of the Congressional Budget Act.