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In This Issue
Diabetes in California Schools
Dear Friends,
DREDF has worked for more than a decade to protect the rights of children with diabetes. We recently forged a partnership with a grassroots organization whose website, Diabetes in CA Schools, we highlight in this issue. Organized by parents Lisa Shenson and Jim Stone, the website contains comprehensive information on the rights of children with diabetes to receive health management assistance at school and to participate fully in all school activities, on and off campus. Please visit this informative site to learn more. Please also visit DREDF's website to obtain valuable information and tools about diabetes care in CA public schools
This eNews issue addresses the situation California children with diabetes face at school
- The Situation
- 2005 Lawsuit, 2007 Settlement, and the creation of the "Legal Advisory on the Rights of Students with Diabetes in CA K-12 Public Schools"
- Nurses' Organizations Oppose the Legal Advisory
- Current Situation in Schools
- Changing the Law in California
- Assistance for Diabetes Families
The Situation
Type 1 diabetes is a common chronic condition that affects over 15,000 children in California. Many of these youngsters receive insulin by injection or through an insulin pump. Some children, especially younger ones, are not yet able to administer insulin themselves and require on-site assistance from someone with proper training in all aspects of diabetes care, including insulin administration.
Federal laws—The Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and the Individuals with Disabilities Education Act—as well as California state law—mandate that schools assist children with their health management needs.
Who can assist children with insulin administration at school? This is the critical question. Right now, despite a "stay" allowing the administration of insulin by trained unlicensed staff, many schools insist that only nurses may do this. Yet less than half of California school districts have nurses at all, and these nurses often move from school to school. In addition, there are not enough nurses to fill current positions.
Children with diabetes need immediate access to a trained adult at all times and benefit from a wide net of support. A traveling nurse system with severe shortages does not work for children with diabetes. Their need does not stop when a nurse is out sick, is attending to other students, or because a nurse cannot access a school—whether because of traffic or a lock-down. Schools need an on-site option for providing diabetes care to their students.
People of all ages and diverse backgrounds routinely learn how to administer insulin safely and appropriately. DREDF shares the view of medical organizations, health care professionals, and diabetes families that school personnel can and should receive training to assist children, which includes insulin administration.
The 2005 Lawsuit and 2007 Settlement
Diabetes families were calling DREDF to report serious difficulties involving their childrens' access to services during the school day. Many parents had to provide insulin themselves at school or were required to remove their children from public school altogether. This led DREDF and Reed Smith LLP to file a lawsuit in 2005 on behalf of the American Diabetes Association and several families in California.
The lawsuit produced a landmark settlement. In August 2007, the California Department of Education (CDE) issued the Legal Advisory on Rights of Children with Diabetes in California K - 12 Schools. The Legal Advisory details the rights of children with diabetes to receive care at school, including their right to test blood glucose levels in class and to participate in field trips and extracurricular activities. The Legal Advisory also states that when nurses are unavailable, trained school personnel may administer insulin to students.
Nurses' Organizations Oppose Legal Advisory
In October 2007, four nurse organizations asked the Superior Court of California to overturn the Legal Advisory. Judge Lloyd G. Connelly ruled in November 2008 that unlicensed individuals could not administer insulin in public schools unless state law specifically authorized such administration.
At the same time, Judge Connelly stated, "If that bill [supporting training unlicensed school personnel to administer insulin] was before me, I'd sign it. It would be law because it makes sense to me."
After the decision, the ADA filed an appeal, and in April 2009, the California Court of Appeal granted a “stay of judgment” pending appeal—this means that the CDE Legal Advisory remains in full force and effect pending the Court of Appeal’s decision. The Court could schedule a hearing date as early as this spring.
The Current Situation in the Schools
Despite this authoritative legal directive, a great deal of confusion exists.
Nurses' organizations maintain that it is illegal for anyone other than a nurse to administer insulin. As a result, a maelstrom of confusion has enveloped children with diabetes and their families.
Diabetes families report to DREDF that many schools are prohibiting anyone other than a nurse from administering insulin, or in some cases failing to provide any form of diabetes care.
Children with diabetes have been excluded from school activities, placed in "diabetes schools," experienced retaliation by the school, and, worst of all, received substandard and at times dangerous care. Some parents have faced loss of wages and jobs so they can provide care to their child at school.
Without the option to train volunteer school personnel, many schools are unable to meet their obligations under federal and state laws to provide care to students with diabetes.
Changing the Law in California
These national organizations support training unlicensed personnel to administer insulin:
Leading diabetes professionals and diabetes organizations know that diabetes care depends on training unlicensed people to administer insulin safely. Unlicensed people of diverse backgrounds—age, socioeconomic level, education, literacy—have been trained to administer insulin successfully.
Passing a bill that clarifies the law to permit unlicensed voluntary school personnel to receive training in administering insulin to students offers a sensible solution that is cost effective, safe and medically supported as well as consistent with existing federal and state law.
In February 2010, California Assembly Member Isadore Hall, III (D – 52nd District), a member of the Assembly's Committee on Health and Chair of its Select Committee on Child/Adolescent Health and Safety, introduced A.B. 1802 to resolve this problem. The bill establishes a procedure for parents to designate voluntary unlicensed school employees for training to administer insulin to their child in public school, based on the medical instructions provided by the child’s physician. The legislation also provides some protection from liability for individuals who volunteer to perform these routine functions.
Approximately half the states in the nation already have laws and/or policies in place that allow non-medical school personnel to administer insulin to public school students with diabetes in situations where no school nurse or other professional is available. In addition, many school districts in California already permit a parent to designate an appropriately trained unlicensed individual to administer medication.
- American Academy of Pediatrics
- American Medical Association
- American Association of Clinical Endocrinologists
- American Association of Diabetes Educators
- Lawson Wilkins Pediatric Endocrine Society
- American Association of Dieticians
- Pediatric Endocrine Nurses Society
- American Diabetes Association
- Juvenile Diabetes Research Foundation
ACTION ALERT
Assistance for Diabetes Families
DREDF has taken the lead for many years in providing services for families with concerns about their child’s safety and services at school, and we continue this important work. We invite families and caregivers to call us about any issues their children with diabetes encounter at 510-644-2555 or toll-free at 800-348-4232.
DREDF has provided and continues to provide assistance to hundreds of parents of children with diabetes in California's public schools and in child care settings, and has advocated on behalf of many of these children at 504 Plan and Individual Education Program (IEP) meetings.
DREDF analyzes monitoring reports about diabetes care inquiries to the CDE, participates in settlement monitoring meetings, and works diligently with the CDE to maintain high standards of care for children with diabetes in California's schools. We will continue to monitor this situation until it is fully resolved and no child with diabetes faces difficulty at school.
DREDF conducts educational outreach to families by making presentations throughout California about the legal rights of children with disabilities at school. DREDF staffers have spoken at hospitals and public health agencies, at ADA Race for the Cure and JDRF Walk for the Cure events, and at JDRF Back to School events.
In Sacramento, DREDF has met with state agencies, including the Department of Public Health, to garner support for legislation allowing trained unlicensed personnel to administer insulin to children in California schools. DREDF has worked with Assemblymember Isadore Hall to develop and introduce A.B. 1802, a bill that provides meaningful care to children with diabetes in public school.
DREDF attorney Charlotte Lanvers shakes hands with Assembly Member Isadore Hall.DREDF and our co-counsel Reed Smith LLP remain committed to pursuing all available means to ensure the safety, health, and legal rights of children with diabetes. Please call us if you need assistance.
Learn more about how DREDF helps children with diabetes.
© 2010
Resources
American Diabetes Association: Diabetes Care at School
Juvenile Diabetes Research Foundation: Type 1 Diabetes in School and School Advisory Toolkit
National Diabetes Information Clearinghouse
Combined Federal Campaign #11944
Support DREDF when you shop.
CONTACT DREDF:
info@dredf.org
www.dredf.org
2212 Sixth Street
Berkeley, CA 94710
510-644-2555