In August of 2007 the American Diabetes Association (ADA) and the California Department of Education (CDE) entered into an agreement that ensured that students with diabetes had access to insulin in school by allowing trained non-medical personnel to administer insulin. The agreement was made to settle a lawsuit alleging that students with diabetes in California were not receiving adequate health services due to a shortage of school nurses and schools not allowing trained non-medical staff to provide those services. As a result of the agreement, the CDE issued a Legal Advisory on the Rights of Students with Diabetes in California”s K-12 Public Schools. The American Nurses Association and several other nursing associations sued arguing that under California state law only a nurse can administer insulin. Last Friday, November 15, a superior court judge agreed and ruled that in California only licensed nurses can administer insulin.
This court decision is not about whether students with diabetes are entitled to have insulin administered at school, if needed. Under Section 504 and the Americans with Disabilities Act, students with diabetes, as persons with disabilities, are entitled to those services to ensure they have equal access to educational services (please see my post Opening the School Door to Section 504 ). This court decision is about who, under California law, can administer the insulin. For now, the California courts have said California law requires that only licensed nurses can administer insulin. But federal and California state law still require that educationally needed diabetes care services, including insulin, must be provided to students.
Unfortunately, in California, there are nearly 14,000 school children with diabetes and only 2,800 school nurses spread across 9,800 California schools. So, limiting administering insulin to only licensed nurses will make it difficult to meet the needs of students with diabetes. But, legally, those needs must still be met. Thus, the American Diabetes Association issued a press release stating that this decision was not in the best interests of children with diabetes and it will continue to work until children with diabetes in California and throughout our country are safe at school.
Filed under: Americans with Disabilities Act, Section 504, children with disabilities
At the school I work for the office has a “health attendant” with a first aid certificate. The office is very small, noisy and often chaotic with children throwing up in the trash can if the bathroom is being used, bloody noses, in-office detention students and parents enrolling or checking student out of class, and answering the phone by the second ring, all at one time with only two of us to do the job. This is no place to give insulin. To have no private, quiet place is our first problem. Next,hired as clerical,even with insulin training I would be to frightened of making a mistake. Having the school back me up legally is no comfort for any harm I may have caused. Also the endless statements, depositions, etc of any lawsuit would be devastating. I would never have worked for a school if this was required when I applied.
Schools will need to be restructured to handle the different disabilities we now include in our population. Autism, diabetes, stomas, and many other conditions. A new world is here and being sure a child is properly cared for and not forced to be sent to a specific school for that care requires a new way of thinking of schools. Parents want them to be pre-schools and after-hours care(homework clubs) with the ability to provide expanded healthcare by trained personnel. The fact is that training for insulin is only the beginning and another lawsuit for another physical condition will come sooner or later and schools will eventually require a nurse at each school..or risk a distracted, well intentioned, trained school clerk nervously injecting your child.
Jan,
Thanks for your thoughtful comments. It is true that serving students with health needs in the public schools requires planning, training, and administrative support. But, as you note, students should not be forced to attend special schools and it is the law.
As a nurse, I think that insulin is too serious of a drug to be given by anyone. I see some of these office clerks and they have enough trouble handling the jobs they already have, on top of that having to give injections of insulin is too stressful. In children especially, depending on what type of insulin, one or two units too much can be very serious. Fingersticks is another huge issue, disposing of the contaminated instruments; are all issues that need to be addressed when training. It’s a huge liability.
Hi Avani,
Thank you for your feedback as a nurse and health care professional. You make good points.