Children With Diabetes Win Assurance of Legally-Required Services at School

[caligirl]

Source: PRnewswire

Children With Diabetes Win Assurance of Legally-Required Services at School

California Department of Education & American Diabetes Association Announce
Agreement on In-School Care for Such Students

OAKLAND, Calif., Aug. 8 /PRNewswire-USNewswire/ -- State Superintendent
of Public Instruction Jack O'Connell joined representatives of the American
Diabetes Association (ADA) today to announce a landmark agreement that
ensures California students who are classified as disabled because of
diabetes will be safe at school and enjoy the same legally-required
educational opportunities as their peers. The agreement clarifies the
rights of eligible students with diabetes in every school district
throughout the state.
"Through this cooperative agreement with the ADA, the CDE is committed
to ensuring that all children with diabetes in California schools have
access to legally required care during the school day," O'Connell said. "A
lack of resources, uncertainty about how services are best delivered, and
lack of clarity about state and federal requirements have in some instances
caused hardship to parents of children with diabetes. No parent should have
to put a job at risk in order to administer legally-required diabetes
treatment to their child during the school day."
The announcement brings to an end litigation, filed by four families
and the American Diabetes Association in federal district court in San
Francisco, alleging that some California school districts were not
providing insulin administration and other services to students with
diabetes-related disabilities who were legally entitled to them while at
school.
Under the agreement, each local education agency (LEA) will manage the
delivery of this care in the best possible way for those students whose
Individualized Education Programs or 504 Plans require administration of
insulin and related services during the school day. The CDE will issue a
Legal Advisory to all California school districts providing guidance on
health care services for students with diabetes and outlining the rights of
these students under federal anti-discrimination and special education
statutes-Section 504 of the Rehabilitation Act of 1973, the Americans with
Disabilities Act (ADA), and the Individuals with Disabilities Education Act
(IDEA). The Advisory explicitly states that school districts have an
obligation to provide insulin administration and related services to
eligible students who need the assistance.


Read more: http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/08-08-2007/0004642037&EDATE=

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WE WON!!!!!!!!!

After fighting my sons school district,( one mentioned in this article, fighting ignorance and cruelty to my son and to me and many other families who endured incredible hardship and significant risk to their child and their jobs it is over and with the best possible outcome. Now I know if a child needs insulin the district I and others fought tooth and nail, finally will follow the law they flagrantly violated for decades. And even better mine will be under watchful eyes of the court for about three years.


It was shocking as a parent and as an RN to find a district willfully refuse to assist my child with insulin should he become unable to give his own insulin in an earthquake due to injuries.


Please forward this article to as many parents of diabetic school children as you can. This will give them hope in their states.August 2007 -

Please also send this link that has specific information for parents of kids in Calif. with diabetes. Parents outside may want to read this as they will be able to see what they should have in place.

http://www.dredf.org/healthcare/diabetes.shtml
Diabetes Care In California Public Schools

In October 2005, Disability Rights Education and Defense Fund (DREDF) working with the law firm of Reed Smith LLP filed a lawsuit against the California Department of Education (CDE) and two school districts (the San Ramon Valley Unified School District and the Fremont Unified School District) on behalf of the American Diabetes Association and four children with diabetes. The lawsuit was filed because many school districts in California were providing inadequate health care to students with diabetes. For example, some districts were refusing to make any school personnel available to administer insulin to a child who cannot self-administer. In August 2007, after a long period of negotiations, settlement agreements were reached with CDE and both school districts.

Read one family's story.

The documents below outline the terms of the Settlement, describe the rights of public school students with diabetes at school and explain how to make sure children with diabetes receive adequate health care in school.

*

Outreach To California Families Of Children With Diabetes About The Legal Settlement Involving Diabetes Care In California Public Schools

*

Services For Students With Diabetes In Public Schools: Questions And Answers For California Parents And Guardians

*

An Important Message For California Families Of Children With Diabetes

*

CDE Legal Advisory On Rights Of Students With Diabetes

*

Sample Section 504 Plan

*

DMMP Form

[babylonsister]

1. In CA. I'm happy for those children. nt

[caligirl]

4. You just would not believe the risk these kids didn't have to endure, now they will be okay.

[babylonsister]

5. Thank you for making it more important. My twin sis is an aide for

'special' kids in CA; she would/will be happy when I share this. Any help has got to be good help.

[caligirl]

6. Your twin has a job that is so important to me as it relates to the well being of kids like

mine. She is underpaid in relation to her value and appreciation felt by parents.

[Maddy McCall]

2. Congrats, Caligirl!

:toast:

[caligirl]

3. thanks, all the hell I went through to see this day! I should frame this

along side the letter they sent me threatening to arrest me and restricting my access to the school after they violated my sons diabetic oversight needs.

[Maddy McCall]

11. It is a victory...

the likes I've never tasted. I fought the educrats and lost. My son is homeschooled now.

I admire you for sticking it out and not letting them intemidate you.

YOU WON! :hug:

[TheMadMonk]

7. And you really thing your country is salvagable or worth saving?

Any other country in the western world and this would have been fought and won in the court of public opinion in a matter of days. Current affairs programming would have seen to that.

You litigate on the flimsiest of excuses on the one hand and force others to litigate against you despite your clearly being in the wrong. (you and yours being your (personal) countrymen)

And in both cases you're hoping for a judge/jury who's judgment is swayed more by personalities than the law as it is written.

[caligirl]

10. sick system isn't it?

[TheMadMonk]

14. And we're becoming infected here in Australia.

Not happy. Not happy at all.

[Lenore]

8. Some School Admin can be so cruel..

I am glad you were able to eventually get justice! We are set to go to Due Process this Tuesday against our District due to their refusal to give my medically needy child adequate services that would ensure her continued placement in school. She's only been in school 3 months of the last two school years, poor dear. So off to court we go!

Why do they make it so difficult??

[caligirl]

9. they hope you don't know the law and that you don't have

a major advocacy group behind you. The only person they respect is your lawyer, and his pockets.

[Lenore]

13. I forgot to mention..

We moved to this current District from CA. We had to sue the CA. District for placement also... 04-00766, if you ever happen by your states Due Process 'Orders and Decisions Database' web page.

The last two years my daughter has been out of placement, we were recovering (emotionally and financially) from our fight with the CA. school system.

I rejoice with you in your victory!!!

[proud2BlibKansan]

23. Not all schools are equipped to deal with medically needy children

Many schools don't even have nurses.

A few years ago, we had a kid in our school who was on a catheter. It had to be changed twice during the school day. But we had no nurse. I can assure you I love kids and I work my tail to the bone to do what's best for them but I have not had one second of medical training that would allow me to change a catheter. Teachers teach, we don't nurse.

But this kid's parents pitched a fit and threatened a lawsuit when our principal told them we were not equipped to meet their child's needs. They thought we were being difficult.

I am glad to see this regulation in California. But if you parents really want to do something that will HELP all kids, especially those who have medical needs, lobby your state legislature to make it a law that there is an RN in EVERY school. NOT an LPN, an RN. Because we can't possibly meet every child's medical needs without a fully licensed RN.

[caligirl]

26. You cannot legislate the sudden or even eventual fix to the accute nursing shortage

that is causing you to be the caregiver, in part. Every parent of a medically diagnosed child would love for you to have an aid and all the support staff possible. i can visit Sacramento daily and demand more nursing schools, i can demand the nursing schools admit more than they currently do and graduate more than they do. It still won't fix this issue. We still have a critical nursing shortage and it is getting worse not better. we could see if the states and feds would ante up thousands of $$ in incentive sign up bonuses to bring inactive status RNs back to work, or we could fix the healthcare nightmare and maybe they would come back then. Diabetic kids are here NOW. they suffer NOW. they cannot wait for a safe day while adults fight and organizations postion themselves. when did anyone ever see a teachers union fight it out for diabetic kids oversight needs(nurses to actually do diabetes oversight) instead of pay raises, reduced teacher:student ratios or benefits? Is it ever put that way? I have actually helped our teachers secure better wages.

the state public education agency must meet state and fed laws and anti discrimination laws and the needs of each student. they must find a way to address these needs even if they have to contract out nursing services privately. That isn't the way i would want it, I would prefer clinically current school nurses with CDE training on a regular basis. But the acute nursing shortage will still be here every September as school starts. I won't ask diabetic kids to wait outside until all the adults get their way.

[proud2BlibKansan]

29. I will not catheterize anyone; I will not give injections.

And I don't know any teacher who will. I am not comfortable doing this; I am a teacher, not a health care provider. Furthermore, the threat of lawsuits has forced school districts to adopt very strict rules regulating what we teachers can and cannot do in terms of health care. I am not allowed to put a bandaid on a student; I can't give them cough drops or even chapstick. I am expecting the day to come when I can't even give them a kleenex.

But you expect us to give injections.

No way. Teachers won't do it and I can't even imagine school districts allowing us to do it.

The answer is a nurse in every school. That is really the easiest way to address this issue.

[caligirl]

30. I think teachers should teach and should be aware of certain health situations that can and

do arise as a matter of common sense and safety due the students by law. How the school districts address the issues you mention is a matter of management and law. they need to consider nurses positions everytime they look at budgets and pay raises. there is a better way to do this and the ADa has found a better way. It does mean these kids will not be victimized by the system and left without an education or witout a life.

[Pavlovs DiOgie]

42. You are my hero!

My son was dx'd with T1 at 6 months of age - he will be 3 next month. I hope that when he is school age I don't have to fight school admin to get a 504 and have quality care for him at school. But I'll fight fight fight if that's what it comes to. I am a teacher - I don't expect teachers to be nurses, but schools are bound to the law and the law says all children get an equal education in a safe environment. If we can afford this ridiculous war, we can afford enough nurses in each school district.

Thanks for fighting the good fight. Those of us on the ADA parents message board heard about this and were ecstatic!

[caligirl]

43. thanks, I checked the parents msg board there but must have missed the posts. any way you can keep

a copy of the settlement agreements on file for your son. If Nevada schools are an issue you will have a document showing them why they should change. I know of an incident in the valley where a dad brought in a copy of the Loudoun County Va settlement and the principal changed his mind about refusals of care. Its the one time I know of. It didn't work in my district which is named in the suit. I sent you a pm regarding my small part.

[LeftishBrit]

12. Congratulations!

Great news! California - and everywhere - should have done this long ago.

You have made an important difference to many people.

[caligirl]

15. kick for more parents and diabetics fighting for the same.

[KamaAina]

16. Now let's get to work on behalf of every other disability

just recently, we had a thick-as-a-brick vice principal tell a kid and his Mom the kid couldn't go to that (public) school any more because he'd been diagnosed with epilepsy! Get this -- the kid was supposed to go to another nearby school that had a more qualified nurse!

We made him stop after about a week. What a :dunce: !

[caligirl]

17. show the moron this law suit settlement, it is illeagal to move a child to another

school for that. Its one of the points in this suit. See the DREDF link i posted. Its in there. He is breaking the law and if he see's it in this suit he may get scared enough to back off.

[KamaAina]

18. This is in HI, not CA

we do, however, have a good friend and ally at DREDF. It's high time we had such a lawsuit here.

The moran in question backed down after our worker showed up, armed (by me) with a copy of the relevant statutes.

[caligirl]

22. great, hey we use to live on Kuukama St in Kailua. Our two souvineers

we brought back are now in college.

[submerged99]

19. Thank you! My niece is Type 1

My little niece is Type 1 and we've had to go through a lot to make sure she gets the what she needs at school.

[caligirl]

27. i hope your schools are more cooperative, if not show them this settlement.

[AnneD]

20. We fought a hell of a battle in Texas recently...

Now those of you with diabetes, and those with diabetic children-don't flame me before you read what I say carefully. I have your children's welfare at heart.

We had a bill recently introduces that would allow a 'trained' layperson to give insulin. I am with the Houston Fed of Teachers and an RN and we opposed the bill as it was written. We desperately want to provide these kids with the care they need so that they can go to school and be 'normal' just like any other kids but we had very serious issues with this 'band-aid approach'.

1) Insulin is a dangerous drug. It is one of the top drugs responsible in medical errors. In fact, most hospitals require TWO RN's to check off the dosage. There are different types of insulin that preform different function in maintaining blood sugar levels. Needles are calibrated differently and can cause one to have to draw up different doses. Someone (not an RN) drew up and administered a dose 300 times (gave 3 cc's. instead of 3 units). The child hit the floor before the med was completely given. She was rushed to hospital and stayed in ICU for a while but she survived.

2) The RN is required to train the lay person that was selected. Now I don't mind showing a person how to do it but the training would have been an hour session in August. Well, that would be OK in August-but would they remember in April-or worse yet in a real emergency. I can handle emergencies and codes calmly-but I have had years of experience and training. And what about that 'lay person' that was 'volunteered' for this duty.

3) There are legal ramifications for the RN. In most states, as an RN, anyone I train practices under my license. So this 'volunteer lay person' that I gave an hour of training is practicing under my license. We we told we would fall under the schools legal umbrella but frankly that is little comfort to me or the dead child's family or the trained lay person. And I for one wouldn't want to be the one setting a new legal precedence here. I own up to my own mistakes, but I will be damned if I will be force to do something I know is dangerous or have someone that is not a Nurse dictate my practice.

After we pointed these errors out, the bill went back into committee and came out with more protective language.

So what is the answer? The Senate Chairman didn't like my response but here it is. We have been legislating, on a disease by disease basis, what rights they have and how to take care of them. This has made for fractured care. The solution is simple-fund a Nurse in every school. Guarantee that every kid has a trained medical person that they can go to. If I had a magic wand-I would put a clinic in every school so kids could get the health care they need-but that won't happen in MY lifetime.

What? You didn't know that there is NOT a Nurse in every school. In some states the ratio of Nurses to students ranges from 1:3000-7000 and the School Nurse Association recommends 1:750 as a starting point. Nurses have multiple schools to go to, so ask what your School Nurses building hours are. Most parents are shocked. It is not like it was for us when we grew up. In the funding crunch-Nurses are frequently the first to go.

I wish parents the best of luck. I deal with kids with many problems and spent all of last year teaching a newly diagnoses diabetic child and her Mom. It is the part of Nursing I love the most, the kind that touches a child for life.

Just remember-I'm fighting for you-not against you. Set your sights on having a Nurse in school for all the kids.

[proud2BlibKansan]

24. Great post!!

You explained the problem far better than I could have.

While I applaud this new state reg in the OP I don't see where it contains the specifics that schools will need to meet the new reg. Typical, isn't it? :)

[caligirl]

25. all of this was discussed and deliberated in the lawsuit and in the CSNO meetings. Diabetes doesn't

disappear at 3 when the school nurse goes home but the child needs to stay after school, for any reason. When the school nurse has to call in sick and there is no replacement the diabetic student doesn't miss the day as well. When the school nurse is off site at a school nurse meeting or training function, there are an abundant number of circumstances that cut right through the 'school nurse only argument' and this lawsuit did just that. Scaring people with overdose hysteria as a cover for the real American Nurses Association/AFT agenda voted on i believe in 2003 of a nurse in every school in every city and state when there is a critical nurse shortage making that a lofty goal at best is ignoring the real life threat to these kids when they get no insulin or glucose checks .The risks to the child who gets no insulin are greater, and 911 is a band aid not a real fix. Paramedics don't give insulin, they aren't trained to give it.
WE ALL WANT school nurses, especially ones who can actually remember insulin is for highs not lows.Not that anyone here would make such an error, but I have personally seen it, including one school nurse who couldn't work a glucometer, never learned how. there are significant road blocks to that goal, nursing schools aren't producing enough, nurses leave the profession due to job stress, etc etc.. Everyone is aware of the nursing shortage. Diabetic kids can't solve this by pretending their diabetes went away at the bus stop.

for anyone wishing to see the campaign of the ANA and AFT and various nursing groups to stop this kind of service, which is based on sound law and recommended by experts in the ADA and Endocrinologists with years of experience with diabetic kids and parents, you can google their organization and meeting minutes to see what has been going on with this campaign. Nursing organizations(CSNO among many) fighting to keep this kind of legal settlement out of all public schools while they use insulin administration by RN's only AS THE TRIGGER to force states to get more nurses into each district without regard to an accute nurse shortage in all areas of of practice and in all states.


The AFT and the ANA and school nurse organizations have teamed up to save jobs for school nurses, to get more school nurses hired and to prevent any legislation allowing for medications to be given by non licensed personnel."the lack of full-time school nurses has been a major issue for the AFT. Last year, the national union launched the “Every Child Needs a School Nurse” campaign to call attention to the issue. The goal is to push for state-level legislation that will mandate a school nurse in every school. Since the program began, school nurse members have lobbied their legislators and have had bills introduced in California, Louisiana, New Mexico, New York and South Carolina.

The AFT also is working with researchers at the University of Pennsylvania’s School of Nursing to study the link between student performance and the presence of a nurse in school. In addition, school nurse members are lobbying their state lawmakers to prevent non-nurse personnel from administering medical treatments to students (see accompanying sidebar)."http://www.aft.org/pubs-reports/american_teacher/nov03/school_nurses.html


Here i googled a list for anyone to read up on the nurse in every building campaign.http://www.google.com/search?hl=en&q=nurse+in+every+school+campaign&btnG=Google+Search


California's standard is 1 nurse to 750 students. The DISTRICT and the STATE have a responsibility to these kids that does not end when a nurse isn't available for an abundant and less predictable number of days that will occur during the school year. CDE's are training parents and family to give insulin and and it has proven safe and effective. RN's do not own the legal turf of state school policy and federal anti discrimination laws.


From the legal brief each school district is required to get because of this agreement, based on LAW:

A. California Law
It is the position of the CDE that the Business and Professions Code section 2725(b)(2) and the California Code of Regulations, Title 5, section 604 authorize the following types of persons to administer insulin in California's public schools pursuant to a Section 504 Plan or an IEP:
1. self administration, with authorization of the student's
licensed health care provide and parent/guardian;1
2. school nurse or school physician employed by the LEA;
3. appropriately licensed school employee (i.e., a registered nurse or a licensed vocational nurse) who is supervised by a
school physician, school nurse, or other appropriate individual;
4. contracted registered nurse or licensed vocational nurse
from a private agency or registry, or by contract with a public
health nurse employed by the local county health department;
5. parent/guardian who so elects;
6. parent/guardian designee, if parent(/guardian so elects,
who shall be a volunteer who is not an employee of the LEA; and
7. unlicensed voluntary school employee with appropriate
training, but only in emergencies as defined by Section 2727(d)
of the Business and Professions Code (epidemics or public disasters).2
1 Unlicensed school personnel are authorized under state law to assist students as needed with insulin self-administration. Cal. Ed. Code sec. 49423 provides that unlicensed school personnel may assist with medication administration.
2 In such emergency cases, an unlicensed voluntary school employee should have been trained to at least the standards specified by the American Diabetes Association’s training slides entitled “Diabetes Care Tasks At School: What Key Personnel Need to know: Insulin Administration” (Attachment A). Such a voluntary school employee should be regularly, and at least quarterly, supervised by a school nurse, physician, or other appropriate individual under contract with the LEA, providing the training, and with emergency communication access to the same school nurse or physician. Documentation of training, ongoing supervision, and annual written verification of competency are strongly recommended, and such documentation should be annually submitted to the LEA employing the unlicensed person by the school nurse or physician.
- 9 -http://www.dredf.org/advocacy/CDE%20Legal%20Advisory%20on%20Rights%20of%20Students%20with%20Diabetes.pdf

Of the type 1 diabetics I have met, all make THEIR OWN insulin dosage decisions starting in middle school. Also, since each child provides their own "insulin syringes" and their own insulin.

Further it was the American Federation of Teachers which voted to stop this kind of agreement at a meeting kthe day John Kerry spoke at their conference.

[proud2BlibKansan]

28. The AFT also represents health care workers

and has a health care platform. I'm sure they had a sound reason to stop this agreement.

[caligirl]

31. I am not aware that the AFT has stopped any court mandated agreement.

I am aware of their resolution that they passed, which the details I sent to the Kerry campaign just before he spoke, like the day before. His health staffer passed them on to his team and no one was to happy that the AFT was using diabetic kids to push for more jobs, sounds cruel and it is. they did not mention any other health concerns faced by students in their resolution. which had its beginnings in school nurses looking for someone to help stop their job losses initially. Not saying health concerns weren't also of concern, just that in these discussions it was more often the job loss that was noted most often.

I cannot agree with the method the AFT and teachers are using to address the situation. discrimination against a particular group,diabetic children, to force a reversal of school nurse job losses is antithetical to the values we stand for. Again organizations can position and threaten as they decide how they will behave, the state education agency still must meet these kids needs, with or without school nurses. School nurse shortages are as bad as nursing shortages everywhere, and screaming i won't i wont I won't solves nothing. further in my school district as in some others, even if we had sufficient numbers of nurses for each school and every field trip and every school and every after school sports event or practice the administrations are governed by unreasonable fear and were refusing to even allow the one licensed group to even give insulin, even in the event of an earthquake and a dose just to keep DKA at bay were the goal. As I said calling 911 daily for lunch time injections or the occasional high is a band aid, not a solution.

And for anyone who is not familiar with insulin syringes, they are not capable of holding 3cc's. It is a skinny syringe with one needle attached already, no gauge guessing required, and the amount it can hold is 1cc. insulin is given in .1 or .o5 increments. My child for dinner needs about .7 or 2/3's of what the syringe will hold. Insulin pumps are like a pager and the amount is dialed up, limits can be set by the parent on the pump so that too much insulin can't be dialed up. Again worse things are more likely to happen to the child without the insulin on a daily and now yearly basis of never getting enough than the risk of getting to much.

[AnneD]

33. Cali...

This person had seen the nurse give this injection many times and the child was on a sliding scale. They did grab a regular needle and thank god she gave it slow and the kid hit the floor before it was given completely. This came up in our state meeting and it happened in North Texas and I won't say more than that but it happened.

Pumps are great to...but there was a case where a sub heard a pump that was low on insulin chime. He saw the tubing, thought the kid had a radio and yanked it out of the kid's pocket and in the process damaged needle and port from what I could understand. On a hunch, I went to the schools website. I found it interesting that they could have a multiple number of football coaches and a number of vice principals (4-and the school was not very big). Imagine my surprise when I saw the school Nurse at this High School was not a Nurse but a clerk. :eyes:

I was shocked I tell you,shocked. :sarcasm:

Cali, it is not just diabetics, but diabetics are the last straw. A few years ago it was asthmatics and their inhaler, next it will be epileptics and diastat gel (given rectally). I have had Nurses that had to give IV antibiotics and chemo and I have had to give trach care and do urinary caths on young spina bifida patients. It is not fair to the kids to be excluded but it is not fair to expect those folks that went into education to become Nurses.

This has become a line in the sand issue. It involves more that giving a shot. It involves the way Nurse Practice acts are written and our legal responsibilities for the safety of those we care for and we think we have legal precedence. I don't want kids to miss a single school experience-but I want them to be safe. Even if I trained and retrained a person-how could I ever forgive myself if they made an honest mistake, how could they forgive themselves. Would they know the actions to take if they did make a mistake. I know and accept the risks I take as a Nurse, and that is ok. But this isn't.

[caligirl]

36. A lot of fear around insulin is lack of time using it>

{but there was a case where a sub heard a pump that was low on insulin chime. He saw the tubing, thought the kid had a radio and yanked it out of the kid's pocket and in the process damaged needle and port from what I could understand.}

This points out the need for recurring training and a serious attitude by the superintendent in the district about training of staff per ADA guidelines in the plans they have developed for all school personnel. Your example was the source of a lawsuit in Florida in the past 5 years or so, a new assistant princpal acted improperly this way as well.The district was sued and training took place. It is a training and awareness issue, not a reason to run from the solution that must be implemented.

Further, our district has opted for the two nurse method in its separate settlement with the ADA and parents. (they will need more nurses!)It will be up to them to have two nurses as they have chosen to do in order to give insulin as the student requires it. This is the way they want to meet the required care. The other district has chosen a different method, which includes asking for volunteers, searching for them, then contracting with a registry if still unable to find someone to give insulin. Again they are meeting the laws, it is their chosen method.


The law has spoken and it is a win for these brave little kids. Perhaps the school nurse organizations could find another method of gaining support for their campaign other than telling parents they "will make it illegal for lay people to give insulin". Diabetics give far more insulin than nurses ever have. Perhaps school nurses must also have CDE's certification. It was my experience that most school nurses had difficulty themselves with the knowledge and skills required to give insulin and monitor this condition. The solution to that,aside from training being kept current for this, is that they have to listen to the patient, and so often school nurses are not used to a patient managed disease. Even the younger patients have alot of input and great knowledge which for a school nurse and school personnel is uncomfortable. (Control issues arose frequently in our experience with school nurses and staff assuming the patient cannot decide how much insulin is needed to correct a high, or sugar for a low.) School nurses should not be so afraid of patient control and parent control of insulin dosing,they have managed this condition daily for years. That is another sore point for school nurses and staff, on this they always want to call the doctor for dosages when the parent and student do this daily as routine.
Tools for effective diabetes management in schools, section 3 at this link.
http://www.ndep.nih.gov/diabetes/pubs/Youth_SchoolGuide.pdf


And I might add, the ADA has never lost a case like this. ;-)

[AnneD]

40. We have another ace up our sleeve here in Texas...

We were able to get an innocuous little bill passed this last session. It requires the school to notify all parents the Nurse's hours on campus. They already have to notify the parents about their child's teacher certification (or waiver) now, it didn't cost anything-so it was an easy sell. Parents are frequently told that there is a Nurse on campus, but they won't tell the parent's that the Nurse is there 2 days a week or only an hour or two a day. Parents just ASSUME we are there and generally shocked when they find out. We hope this notification will shed some light on the situation. Parents, esp those whose kids have health issues are our best allies. My diabetic child's mom wrote letters in support of the notifications, a Nurse in every school, and against a lay person (despite training) administering insulin. I think this type of notice will shake up a lot of parents and maybe prompt some action. Goodness knows the schools don't listen to us now.

I am sorry that you have had trouble with school Nurses and insulin-but THIS School Nurse knows it inside and out and frequently fields questions from my union member Nurses. I even help monitor a teacher that had a transplant (I think it was an islet transplant). I started giving my step-grammie her insulin shots when I was 10 (under her supervision). Call me a pessimist but knowing what I know, and human nature being what it is- I see too much of a down side on this.

[caligirl]

41. i have spoken with my representative about more school nurses as well. I was told

the funding needed to do what the CSNO wants, more nurses in schools, isn't likely to ever happen. I was disgusted with the attitudes I found in Sacramento regarding increased funding for this. My hope is that now the Jack O'Connell has gotten his 'education' via a federal lawsuit which is considered a landmark case, he will go to the legislature and Governor and get more funding. But this issue is bigger than just more nurses, kids are hurt by bad and misguided decisions on the part of administrators from the state level down to the classroom level. State education agencies need an 'education' as California just got.

[AnneD]

32. In my long career as a School Nurse-

I have had the privilege of taking care of kids of all ages-and that includes kids with every kind of chronic and genetic disease. The Nurses have begged the district to hire sub Nurses or at least increases the number of itinerant Nurses (cover for Nurses that are out long term for pregnancies etc). We have only 2 such Nurses for 260 schools. We have had no luck.

Our Nurses are very conscientious of our duties. When I have to be out-I notify ALL of my parents personally so they now I am off campus (I now work in an elementary school). Because our district believes in a Nurse in every school-we can call a nearby school and the Nurse at the nearest school will help cover in the case of an emergency. The parents and I have worked things out on a case by case basis. They have a trust in me and know we will do what we can. Children in middle school and high school should be able to take care of themselves, but I have always insisted on having back up syringes and insulin in the clinic because...well, I know kids.

Since this law has passed, I know many Nurses that very worried about their ability to maintain a safe practice. Many have not dealt with insulin since Nursing school years ago (yes it is possible) and are worried about teach it, giving it, and BEING RESPONSIBLE- AS IN YOUR LICENSE for those administrating insulin. Teachers and other lay folk worry about being 'volunteered' for these assignments. They want to teach, not to play Nurses. Many are afraid to tell the principal no for fear of retaliation. Yes the AFT, ANA, and other school organizations have teamed up on this but not to 'save jobs for Nurses' but to insure the safety and health of school age children. California may have a good ratio of 1 Nurse to 750 kids-but that is an exception. It is not hard to get a Nurse to work in a school-but you have to have a position and you have to pay them. Most districts won't do that until they face a lawsuit.

Frankly, I am getting sick and tired of everyone telling me how to run my practice. I saw none of these folks in my Nursing classes or taking my boards. And I am sure that when an accident happens and a child dies from an improper dosage of insulin from a lay person at my school-I will NOT see any of these folks at the board hearing when they try to yank my license from me. Look I am on the front line in this and I have lots of experience backing me up and this is not safe. I will leave school Nursing before I have someone dictate an unsafe practice to me. I have no problem taking responsibility for MY action-but I will not be responsible for someone elses, especially when I objected to it from the begining. I will not compromise on childrens safety.

Oh and by the way, there is NOT a Nursing shortage currently (that will start in earnest in 2011 per GAO), there is just a shortage of Nurses unwillingly to engage in an unsafe practice.

Flame if you must but I am a member of AFT and I was consulted on their stance and I will stand by it as will the other Nurses that make up our local. Oh, and the Administrator Organization (principals union) the Superintendents and other teacher's organizations were at the hearing to speak against the bill before it had the safeguards added. Even they recognized the dangers.

[AnneD]

21. dreaded double post...

eom.

[kineneb]

34. given insulin pens and pumps, I can't figure out why the problem

Hubby is type II, and was on insulin until he lost (too much) weight. He is needle-phobic, and yet was able to give himself injections. The pens made his life so much easier. I have no formal medical training, and I was able to give him injections, after having basic instruction from the doc.

I can understand not wanting to deal with serious medical equipment in the classroom, but jeez, an insulin pen? And when the child is old enough, they can use it themselves, and so won't need the teacher's help. Some regulations are just plain silly.

And congrats; I heard about the decision on KGO radio.

[caligirl]

35. thanks! the issue is school nurse liability for training unlicensed volunteers

to give insulin. Its not rocket science or brain surgery. But the "nurses only" belief is based on issues other than the reality of the situation at hand. it is more dangerous for the diabetic to not get his insulin as a parent in Upland found out when finding her small child semiconscious out on the ground due to lack of insulin at school. The school nurse refused to allow anyone else to help with diabetes care for the child as a matter of standard practice and as a result when the child complained in the office of DKA symtoms she was ignored, fed marshmellows and sent to the playground. that is where her mom found her with a BG of nearly 600.

[Hekate]

37. I truly hope this will be more impetus to put a nurse in every school...

I've been appalled to read that medical care often falls to school clerks and secretaries, because the nurse must serve several schools.

Hekate

[caligirl]

38. that would only solve a part of the problem, the nurse can't be everywhere the kids are

and they are absent as well at times. this issue needs addressing in states and districts from the top down in terms of attitudes, oversight, laws, training of school nurses( we saw many who weren't competent in diabetes care. I hired my own CDE to train two school nurses for my child after they clearly didn't know what they were doing with basic equipment and showed absence of working knowledge of daily diabetes management)Yet the clerk at the school my child had just left in going from jr. high to High school, knew exactly what to do, assisted the students with rechecking their math via calculator for their insulin dose and lunches. She recorded their blood sugar and called parents for any questions. After my child moved on i stopped sleeping well and feared for his safety under the school nurse who didn't do any of this. the clerk monitored the kids extra food supplies, extra diabetes supplies and kept a watchful eye on each one. she knew them all and took her responsibility seriously. she didn't have to do any of this. She lost an uncle to the disease, and so this was what she wanted to do. She did a better job than any of the school nurses i met or dealt with at the other school, same district. Competence and training as well as attitudes matter. Don't assume a school nurse solves all problems. They made our district unsafe for diabetic kids in concert with the district administration. the only time i ever heard of a nurse in our district trying to do the right thing, he left with a letter warning them a lawsuit would come if they didn't change. Years later it did, now they will.

[Hekate]

39. Thanks for the info, Caligirl.I just hope things improve drastically...

...for everyone's sake. :hi:

Hekate

[bobthedrummer]

44. A related cross-post for all of US, from a developing parent thread

"This just in: 'Giuliani Seeks Private School Vouchers'..."
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=186x21683#21901