Ruling lets school staff give insulin to students
The California Supreme Court ruled Monday that school employees other than nurses can administer insulin to diabetic children, a decision that diabetes advocacy groups said would make schools more accessible to the children and lift a burden from their parents.
The unanimous decision overturns a lower court ruling that said only licensed nurses could provide insulin on school campuses. It supports a previous agreement between diabetes advocacy groups and the state Department of Education that had allowed schools greater flexibility in determining who can give insulin shots.
The American Nurses Association criticized the decision, saying that allowing unlicensed school employees to deliver prescription medication could be unsafe for children and undermine the role nurses serve in public schools.
The nurses association had argued that state law correctly allowed only licensed health care providers – along with parents, family friends approved by parents or the children themselves – to give insulin shots to diabetic students.
But the court found that there’s no reason to believe that only nurses can provide insulin shots, especially when other unlicensed people – including parents and children as young as 8 who are able to self-medicate – can give them safely.
May be appealed
“We’re thrilled with the decision to help keep kids safe in school,” said Dwight Holing, chairman-elect of the board of directors of the American Diabetes Association, which was part of the original lawsuit that set off an eight-year legal battle in California.
“Today’s decision doesn’t in any way lessen the role of a school nurse,” said Holing, an Orinda resident who also has diabetes. “What this decision does is provide schools with a backup plan to be able to provide care for kids with diabetes when a nurse isn’t available. Diabetes is a 24/7 disease – it isn’t part-time.”
The nurses association, which was pitted against the American Diabetes Association in the case, said it would consider appealing Monday’s ruling to federal courts.
The American Nurses Association has “fought to ensure that children with diabetes and other conditions that require health care services receive the level of care in school promised to them by law,” the association said.
“This decision lowers this level of care for children … and puts them at risk for medication errors that could have severe health consequences,” the association said.
The ruling clarified state laws on the matter that were confusing and open to interpretation, said Dennis Maio, an attorney who, along with the Disability Rights and Education Fund in Berkeley, represented the diabetes association. Most schools opted to leave insulin shots in the hands of nurses, he said, but some school districts allowed staff members who weren’t nurses to provide insulin shots to children.
All schools will now be required to allow nonlicensed staff members to give insulin after proper training and with the approval of the student’s doctor. Maio noted that no staff members will be forced to get the training. Instead, schools will rely on volunteers, and schools won’t be required under the ruling to provide a volunteer if one doesn’t step up, he said.
“We just want to make sure if somebody is ready, willing and able to do this that state law doesn’t stand in the way,” Maio said. “That doesn’t guarantee there’s going to be somebody – it guarantees there’s no legal impediment to it.”
Supporters of the ruling said it will make life easier for the parents of diabetic students, who sometimes have had to skip work or even quit jobs to care for their children during school hours, and make schools more accessible for those students.
Roughly 14,000 children in California have diabetes. Those children often need multiple insulin injections every day, and depending on the medication regimen worked out with their physician, students may need one or more of those shots during school hours.
Only 5 percent of California schools have a full-time nurse, and 26 percent of schools have no on-campus nurse at all, according to court records. Statewide, there is only 1 school nurse for every 2,200 students.
What about teacher liability when things go wrong?
Some families, out of necessity, have moved to school districts that had more lenient policies about who could give shots to children. Other families chose to teach their children at home, at least until they were old enough to give themselves shots, according to diabetes advocacy groups.
“It takes a village to raise a kid with diabetes. You can’t just designate one school nurse (to give the shot) because they’re not around the kid all the time,” said Barbara Wright, an Albany parent whose son, Jonathan Mahmoud, is 16 and able to handle his own medication now.
But when he was 5 and newly diagnosed, Jonathan couldn’t even prick his own finger to check his glucose levels, Wright said. Fortunately, the Albany School District was happy to work with the family, she said, and it offered to train multiple staff members to help monitor his diabetes.
“They’ve been saying from the beginning, ‘What can we do to help him stay safe in school?’ We’re the best example of what schools can do,” Wright said. “It’s something everyone’s involved in, and not a nurse who maybe comes once a day or as needed.”