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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.