What happens if a state rules that ONLY NURSES can administer insulin to diabetic kids at school, but there are no more nurses?! This is currently the case in California, broke and cutting school budgets left and right. Now, a state appeals court has issued a ruling that finds state law means school staffers who are not trained nurses should not be allowed to give injections, under any circumstances.
A family in Pacifica, CA, writes to me:
“It is extremely worrisome. We have a 7-yr-old diabetic and don’t know what we are going to do next year.”
I have a 7-year-old too. She’s very bright, but seven is still too young to make big, important decisions for yourself. My little one doesn’t have diabetes, but I think about that eventuality all the time. If she did, how would I feel about sending her to school where NO ONE is authorized to help her with her diabetes?
In California, it used to be OK for “trained non-nursing employees to test 
children’s blood sugar, if a child is unable to do so, and to administer insulin whenever licensed nurses are unavailable.” But that’s what’s been overturned in this new ruling, it seems.
If this is going on in California, then I’m quite sure similar conflicts are taking place in other states.
How could a ruling like this possibly be beneficial to anyone, I wonder?
From reading the coverage, it looks like the American Nurses Association is protecting its territory. They claim that allowing anyone other than trained nurses to administer insulin is “dangerous, requires substantial scientific knowledge to safely administer, and poses a significant risk of harm if administered in error.”
Why yes, there is a risk of error — and we People with Diabetes take that risk multiple times every day. Do the nurses believe that leaving young diabetics to grapple with insulin dosing at school on their own, without the help of (any) knowledgeable adult, is somehow less risky?!
I am upset about this, as I’m sure many parents and other advocates are.
Thankfully, the JDRF is actively advocating, and also the American Diabetes Association is working hard to overturn the ruling. They’ve issued a statement, which includes this comment from the ADA’s Chair of the Board:
“Every child with diabetes has a right to be medically safe at school and the right to the same educational opportunities as his or her peers.”
A self-evident truth, no? It’s just beyond frustrating when political and economic concerns seem to trump concerns over children’s basic safety…
One of the biggest points on this is that parents don’t always have the time to drop everything and help their child out one, two, three times a day at school. Both parents may work.
Who suffers with this decision? The child. There has to be a better way.
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it’s not about safety, it’s about job security. The California Nurses association(s) figure that if they make it a law that only they can inject, parents will fight even harder to keep nurse jobs in the schools (rather than share nurses between campuses, or replace with clinic aides and not licensed nurses.) The problem is, no matter how hard parents and nurses fight, if there’s not enough money then there’s not enough money.
As a parent of an elementary-schooler with diabetes, I’d also be bothered by the state telling me that I can’t decide who can act in my stead if needed (be it the nurse, an aide, a para educator, a teacher or even the school secretary – if they are willing to learn, and many are.) Even at the middle school level, I rely on the nurse to assist Jake periodically.
Ryan injects 1-2 times per day at school. He checks his blood sugar as many as 5 times (on PE days). If we didn’t have a school nurse, I’d have to quit my job and be at the school all day, every day, or I’d have to band together with the other parents of kids with diabetes and hire someone to take care of them (which is a whole ‘nother can of worms).
There may be a work-around…
“State law also allows insulin injections by the student, the student’s parent, or a relative or friend designated by the parent.”
We may just have to designate the appropriate administrator as a “friend”.
I’d find a “friend” that was my child’s teacher. Quickly. I was lucky as a kid growing up w/ diabetes. We didn’t have nurses, but had great teachers and I was taking only 2 shots a day, so there was no worry about insulin at school (it was the mid-80s). I worry for the children and the families.
I just hate to see this issue continue to plague the children and families trying to live with diabetes in California. I sympathize for anyone trying to protect their livelihood in this economy, but not when children are ultimately going to suffer simply because they have type 1 diabetes. That falls into unconscionable territory, so shame on all the involved nursing associations for making diabetes management that much more burdensome for all of these families.
What happens if a differant child requires tube feeding during the day? Doesn’t the school have to provide or does the parent have to make the arrangements.
I know that in some hospitals, that there is a double verification of insulin when administered by nurses.
I have 3 little guys with T1 in the California school system. There nurse is at school one morning a week. It just isn’t right. I don’t work, so last year I ran down everyday to take care of my kidergartener, and my other boys would call me with their numbers at least twice a day each, and we would discuss insulin dosages and carb amounts. Luckily they have pumps…if they didn’t, oh my gosh, I can’t even THINK about it. The nurses union is being completely selfish, if they thought of these children as their own, they would be singing a different tune.
The point of these regulations is to remove your kid from public school. The point of education reform has been to destroy public education. You might as well find a private school to send you child to.
Here in Quebec, Canada we live with this difficult situation all the time. Kids can get lunch shots and testing only if people at the school are willing to do it out of the goodness of their heart (they are protected by law once the parent agrees to have a proxy). All schools have nurses yes, but because we have a shortage of nurses (including school nurses). School nurses have several schools to oversee instead of only one. Therefore the nurse is not always there. The other option is to use Nph/N injections at breakfast. This is not the best option but it does work.
The point of this legislation is to protect school nursing jobs. It’s also in place to protect the teachers. I am diabetic and I had a diabetic child in my class once. I couldn’t manage both of our diabetes AND teach.
I agree with Kassie — I don’t think there’s any way that eliminated nurses jobs are coming back, with such huge budget deficits. So in their absence, this ruling is a terrible move because as Kassie says, parents should at least be able to determine who can who can act on their behalf.
This is sad indeed. As a lifelong t1 I like to think I am “qualified” to be a caregiver and would gladly offer to help, if only to make up for the absolute lack of suport I received as a CWD in school. The CNA is going about this the wrong way.
Great and important post, Amy. Just to let you know, it was a California appeals court panel that issued this ruling June 8 – the state dept. of ed was the party sued by the American Nursing Association and got this ruling in an appeal after a lower state judge found the same. Based on state law, as it’s written. I wrote about this on my blog today, as well. Parents need to be made aware and must advocate to the California lawmakers to change state law.
Also, to Bill Halper: there isn’t a work around in allowing any school employee from being that “friend.” Part of the ADA’s argument in this case was that they could be designated to do so, but the court said that wasn’t possible based on how the law is written. So, only friends or parents or someone who’s not affiliated with the school system can do this. But yes, the student can do it themselves – if able.
My sister lives in Colorado. None of her kids has T1, thank God, but I know there are no school nurses in that state. However, there is some sort of educational outreach program that they have for kids with T1 in school. I believe you can find it on the Children’s Diabetes Foundation website.
I almost can’t believe I am reading this! How could there be no school nurses? There should always be a licensed nurse available at the school at all times. I think it’s unacceptable if there isn’t.
Things have changed quite a bit since I was in school, I guess!
In the original suit, the plaintiffs (students with diabetes) argued pre-emption (they said state law frustrated implementation of federal law). This persuaded the State Board of Education to enter into a settlement agreement. The problem was the settlement agreement permitted what the legislature had not—the use of trained volunteers.
Morally, medically and from a policy perspective, the settlement agreement was sound. But legally it couldn’t hold because compliance was possible as long as a nurse was provided. Of course, CA doesn’t have enough nurses or any money to pay them but that’s a different question and it wasn’t one for the court. The question was “What does state law allow?” and on that question the nurses were correct.
Here in Illinois we chose to exhaust the legislative path and after more than six years, The Care of Students with Diabetes Act finally last month. It provides for the use of unlicensed trained aides. It’s waiting for the Governor’s signature.
If we had failed again, we would have sued but we would have sued FOR a nurse for every child with diabetes. It’s a totally absurd position but it is one the law would have supported. Those suits would have likely prevailed and they would have ultimately driven the legislative change needed. But they would have also cost the state a fortune and they would have devastated the perception of nurses—nothing we wanted.
The California decision affirms that the correct fix to this problem is legislative. In fact the ruling acknowledges the problem and states the solution plainly–change the law. Advocates in California are working now to do just this. Join them. They have a lot of ground and a lot of legislators to cover—from Crescent City to Chula Vista. They need your help.
To see what we did in Illinois, log on at http://www.thecareact.com/Progress_Report.html
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