California State Supreme Court’s Unanimous Ruling to Protect the Safety and Health of California Schoolchildren with Diabetes Benefits All People With Disabilities
Disability Rights Education & Defense Fund (DREDF), representing the American Diabetes Association (ADA), with co–counsel Reed Smith, LLP, is extremely pleased with the California Supreme Court’s unanimous decision in American Nurses Association v. Torlakson, a landmark case involving diabetes care in California public schools. Today’s decision made it clear that state law is not an obstacle to children with diabetes receiving the proper care they need to be healthy and medically safe at school. The California Supreme Court agreed with plaintiffs’ interpretation of state law to allow school personnel, who are not nurses, to volunteer and be trained to help children with the insulin they need to survive and thrive at school.
“Today’s decision is a critical victory for the estimated 14,000 California schoolchildren with diabetes and their right to diabetes health related services in school and during school–sponsored activities,” said Larisa Cummings, DREDF Staff Attorney. “We’re equally excited to see the practical realities of living with a disability and/or chronic illness safeguarded by established law.”
This case has implications for many people living with other chronic conditions and/or disabilities, including those that are age–related. People with disabilities’ ability to access services such as administering medication through attendants or other caregivers is integral to living independently in the community or receiving affordable residential care elsewhere. The question of who can provide what type of service is crucial to the people who need those services, and it is an issue that links a diabetes-related case with the broader disability rights community.
This is a very broad decision that covers many more settings and situations than public schools in CA — e.g., licensed care facilities, including child care, IHSS workers, etc. From the opinion: “For all of these reasons, we conclude the medical–orders exception does permit a layperson to carry out a physician’s medical orders for a patient, even orders that would otherwise fall within the definition of nursing practice, without thereby violating the rule against unauthorized practice. To fall outside the exception by “assum[ing] to practice as a . . . nurse” (Bus. & Prof. Code, § 2727, subd. (e)), one must go further by holding oneself out, explicitly or implicitly, to be a nurse in fact.”
DREDF recognizes the vital role school nurses play in maintaining the overall health of all students, including those with diabetes, and that all people with disabilities benefit from access to high-quality health services. But this need not conflict with the fact that, for many people with disabilities, their everyday lives include tasks that are medical by label but routine in practice. This has already been reflected in the law.
As argued in the ADA’s Opening Brief on the Merits (2010), the California Nursing Practice Act’s language,
“clearly does not prohibit unlicensed persons from administering medication categorically, this Court need not look beyond the statute’s words. But if it were to do so, it would find confirmation in the consequences flowing from the competing constructions. For instance, in many types of settings licensed by the California Department of Health Care Services and the California Department of Social Services, unlicensed persons are authorized by regulations to administer medication to persons dependent on their services. Such facilities include child care centers [see 22 Cal. Code Regs. § 101226(e)], adult residential facilities [see id. § 85065(f)(1)], intermediate care facilities [see id. §§ 73313( c), 76347(i)], and correctional treatment centers [see id. § 79635(a)(6)]. The purpose of the NPA, of course, is to protect and promote the health and safety of the public. In view of the great benefits promised to public health and safety if services to dependent persons continue, it is reasonable to construe the statute not to prohibit unlicensed persons from administering medication. And in view of the commensurately grave costs threatened if such services end, it is absurd to construe the statute otherwise.”
The case came before the California Supreme Court after more than seven years of litigation, which began with a class action lawsuit that was resolved by a settlement agreement allowing trained non-medical school personnel to administer insulin when a nurse is not available. That provision of the settlement was challenged in the current lawsuit by several nursing organizations, leading to today’s decision.
“This is a wonderful victory and an historic one. The question of what is ‘medical’ versus what is ‘daily living’ is a continuing and critical issue in the disability civil rights / independent living movement. The ability to live in the community is premised on the idea that disability needs can be met outside of the medical setting. When the movement started in the 70’s, disabled people were put in nursing homes and institutions because they needed help grooming, eating, and other activities of daily living. While it may seem ludicrous today that feeding a person with quadriplegia was considered a medical service, any help to anyone who had a disability was the province of the medical profession. This decision today is a gigantic step forward in this important history. DREDF is thrilled to have been a part of it and we thank everyone who who put their heart and soul into this very worthy and historic endeavor,” said Arlene Mayerson, DREDF Directing Attorney.