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Legally speaking: Diabetes and the school-age child

Friday July 18, 2014
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About 208,000 Americans younger than age 20 are estimated to have diagnosed diabetes. Most in this group attend schools in grades one through 12. The majority of these school-age youths have Type 1 diabetes requiring insulin injections or an insulin pump.

Not all students with diabetes can manage their own care. A child younger than 8 has no or limited abilities to provide the self-care necessary to complete the mandated tasks of checking blood sugar levels and administering insulin. After the age of 10, some students can manage these tasks. By middle school and beyond, the student with diabetes should be able to perform these responsibilities.

Recent controversy has arisen about who should administer insulin to a student or manage a school student’s insulin pump and perform glucose monitoring for students. Clearly, registered school nurses are in the best position to fully meet the students’ complex, daily healthcare needs and provide the overall management that is required by this chronic disease. Unfortunately, there is a school nurse shortage. As a result, other school personnel are performing the duties of the school nurse for the student.

Section 504 of the Rehabilitation Act of 1973, the Individuals With Disabilities Education Act and the Americans With Disabilities Act protect the student with diabetes from discrimination. In addition, any school that receives federal funding or any place of “public accommodation” under the ADA must reasonably accommodate the special needs of students with diabetes. These laws require an individualized assessment of the needs of the student with diabetes while in the school setting. It is the school RN who is responsible for developing an individual health plan for each diabetic student and providing continued management and evaluation of the established plan in the school setting. The school nurse’s involvement in the life of the student with diabetes while at school has been shown to improve the management of the student’s disease and his or her academic performance.

However well-intended school personnel are in providing the needed monitoring and insulin administration to the diabetic student, their respective skill levels to do so vary considerably. In some instances, the non-nurse school personnel have limited training in the care needed for the diabetic student. Others do not have any training. The decision to train or not train other school personnel to provide oversight of the student and to administer insulin to students rests with each state legislature. Even so, the popular argument goes, “someone” providing care is better than the student receiving no care or no insulin.

The debate about who is best suited to provide the needed care and management of a student with diabetes in the school mandated by federal law will continue for some time. Recently, in a well-publicized case brought by the American Nurses Association and other professional nursing associations, the California Supreme Court held that trained, unlicensed school personnel may administer insulin to diabetic students with the permission from the student’s parents and the student’s physician. Although only controlling in California, this case has implications for all schools and all registered school nurses.

If you are a parent with a child with diabetes in the school setting, you need to become knowledgeable about who is caring for your child if a school nurse is not present. What kind of training is provided to the non-nurse school personnel who is administering your child’s insulin and/or making decisions about how acceptable the child’s blood glucose levels are? Uncontrolled glucose levels and poor healthcare management of diabetes can result in long-lasting complications. Acting now can help your diabetic student receive the best care possible, be a successful student and be as healthy as he or she can be while in the school setting.

Sources

• “Diabetes In Youth,” Statistics About Diabetes: Overall Numbers, Diabetes and Prediabetes (2014), 2. Data released from the National Diabetes Statistics Report, (2014), 201. Available at: www.diabetes.org/diabetes-basics/statistics. Accessed June 22, 2014.

• “Care of Children With Diabetes in the School and Day Care Setting” (2007), 26(131), Diabetes Care, 1. Available at: http://care.diabetesjournals.org/content/26/suppl_1/s131.full. Accessed June 21, 2014.

• National Association of School Nurses (2012). Position Statement: Diabetes Management in the School Setting, 1. Silver Spring, MD: author. Available at: www.nasn.org. Accessed June 21, 2014.

• American Nurses Association et al v. Torlakson, 304 P. 3rd 1038 (2013).

To see what else is trending, visit www.Nurse.com/Diabetes.


Nancy J. Brent, RN, MS, JD, is Nurse.com’s legal information columnist and an attorney in private practice. This article is for educational purposes only and is not to be taken as specific legal or other advice. To comment, email specialty@nurse.com.