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ANA goes to court over school insulin administration

Tuesday May 28, 2013
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The American Nurses Association is set to argue before the California Supreme Court in a case that pits it against the American Diabetes Association.

The issue at hand is whether unlicensed personnel can administer insulin shots to children in California schools. Two lower courts previously ruled that the California Department of Education’s attempt to sidestep the state’s Nursing Practice Act by allowing unlicensed personnel to administer shots was unlawful.

The diabetes association and others appealed to the state’s Supreme Court, which will hear arguments beginning Wednesday. The ANA, California Nurses Association and California School Nurses Organization have argued that California’s Nursing Practice Act "specifically defines administration of medication as a nursing function that cannot be performed by unlicensed individuals, except in certain circumstances that do not apply in this case," according to a fact sheet from the ANA. Under the law, RNs "must only delegate the administration of insulin to competent licensed personnel and can be subject to disciplinary action if they delegate to incompetent or unlicensed individuals."

A decision negating the Nursing Practice Act "would put children at risk," according to the ANA. "If that were to happen, schools will rely on secretaries, cafeteria workers, teachers and other unlicensed personnel to administer insulin, a dangerous drug, to the youngest and most vulnerable students who are unable to manage their own health conditions." Data show "many children have suffered needlessly because unlicensed, untrained volunteers and designees administered their medication."

National implications

A reversal of the lower courts’ rulings would set a dangerous standard by denying the California Board of Registered Nursing "its right to define nursing practice," according to the ANA. "Consequently, a precedent will be set that will undermine the authority of the board that is authorized by statute to protect the public through regulation of nursing; consequently, the power of all state boards of nursing will be diminished, as will the nursing profession’s self-regulation, based on mere convenience or cost."

As well, if the court "finds that federal disability laws preempt state healthcare licensing laws, no state will be able to establish qualifications for individuals who provide healthcare pursuant to a 504 plan," according to the ANA. Section 504 of the Rehabilitation Act of 1973 requires the needs of students with disabilities to be met as adequately as those of students who do not have disabilities.

"It would be the first time that any state healthcare licensing law has been preempted by federal disability law," according to the ANA. "The two laws currently work in relationship with each other, permitting the state to control how healthcare is regulated consistent with anti-discrimination and accommodation requirements of federal law."

The ADA’s view

After a California appeals court upheld the initial ruling in favor of the ANA’s argument, in June 2010, the diabetes association stated: "Children with diabetes are in danger as a result of this ruling, because there are not enough nurses or other licensed healthcare personnel available in California’s schools to administer the insulin that young students with diabetes must have in order to be safe at school. … Indeed, diabetes experts agree that permitting trained non-medical school personnel to administer insulin is in the best interests of these students."

The ANA noted that the previous court rulings "do not prevent students with diabetes in California’s public schools from receiving the health services to which they are entitled. California law permits several categories of individuals to administer insulin in the school setting, including parental designees."


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