Committee reviews H.209 to add intranasal epinephrine to school stock

The House Committee on Education on Feb. 27, 2025, heard testimony on H.209, an act to authorize intranasal epinephrine as part of school stock medication. Testifiers including school nurses said intranasal formulations could help address shortages and reduce costs for school nursing budgets.

The proposal would add intranasal epinephrine to existing law that permits schools to maintain a stock supply of epinephrine auto-injectors. Kathleen Goodell, a school nurse in southern Vermont, told the committee that recently the district could not obtain stock auto‑injectors, forcing schools to buy replacements that cost about $500 per school and strain nursing budgets. Goodell said an intranasal product recently approved by the U.S. Food and Drug Administration is being offered through a program that provides four single‑use doses free to each public K–12 school; she said the current formulation is approved for students weighing about 66 pounds and up and that a pediatric dose is expected to be submitted for approval in the coming months.

Kelly McGovern, president of the Vermont State School Nurses Association and a school nurse at Middlebury Union High School, said she and other nurses support adding intranasal epinephrine to statute but urged changes to the bill's wording. McGovern said several provisions could be read to allow a school administrator to authorize non‑licensed personnel to administer epinephrine, which the nurses believe conflicts with Vermont's Nurse Practice Act. "Only a licensed nurse, either an RN or an LPN, can delegate patient care in a school," McGovern said, and she asked the committee to tighten the language so that delegation authority remains with licensed nurses.

Nurses also recommended clearer terminology for who may prescribe or write protocols. McGovern and colleague Clayton Wetzel urged replacing or clarifying the phrase "health care professional" and, in several places, using "health care provider" where a prescriber is intended. They also recommended that protocols for storage, procurement, administration, and training be written by a team (nurses, the prescriber, and school administrators) rather than implying a single prescriber writes them alone. Wetzel noted that H.209, as drafted, addresses stock use for undiagnosed anaphylaxis but does not explicitly address stock use for students with prescribed emergency medication or self‑administration; nurses urged the language permit stock use for known allergic students when needed.

Katie McGlenn, legislative counsel, told the committee some of the suggested wording changes could be made and that the statement of purpose lines are more constrained at this stage. McGlenn and committee members encouraged legislative staff to work with the Vermont State School Nurses Association to draft clearer language and bring a revised version back to the committee.

No formal action or vote occurred during the hearing on H.209. Committee discussion focused on statutory wording and implementation details rather than final enactment.

Implementation and next steps noted at the hearing included follow‑up drafting with nursing stakeholders and Legislative Council. Testifiers identified potential cost relief from manufacturer programs for intranasal doses but also flagged equity concerns where some districts may lack a consulting prescriber to write standing orders; nurses suggested consideration of a state standing order from the health commissioner to address that gap.