UPDATE, August 13, 2013: The California State Supreme Court unanimously agreed yesterday to allow "trained personnel" who are not nurses to administer insulin in public schools to diabetic children (see full history of this case below). The decision says "...California law expressly permits trained, unlicensed school personnel to administer prescription medications such as insulin in ccordance with the written statements of a student's treating physiciann and parents." At issue now with the plaintiffs (the American Nurses Association) will be the definition of "trained" ...At left, California Supreme Court Justice Carol Corrigan who, in the May 30, 2013 hearing remarked, " “If my child has a life-threatening insulin problem, either do I hope that (he) can inject himself…or do I rush home from work – is that how it works?” UPDATE, May 30, 2013: Lawyers haggled yesterday over whether any special training is needed to administer insulin shots to diabetic school children, as the American Nurses Association v. Tom Torlakson case was heard before the California Supreme Court in San Francisco.
According to Henry K. Lee's report in SFGate, "...some justices seemed skeptical" about the argument by ANA attorney Maureen Cones' argument that "licensed professionals ...have the required technical skill and scientific knowledge" necessary to give the shots.
...Cones countered that a child's need for an insulin injection could be considered a critical situation, but not an emergency, and that licensed nurses are needed to ensure that a child doesn't have a serious reaction to insulin. That would be an emergency, she said.
Cones said children who self-administer know how they will react, and their parents are in the unique position of knowing how their kids are feeling.
"And a nurse would know all of that?" Corrigan asked.
Cones responded that nurses are trained observers. Asked by Justice Ming Chin if she would be satisfied if a school employee was given all the information about a child and his or her specific needs, Cones said, "No. The law says what it says." ...
A group of parents who launched the case said the rules were unworkable because of California's shortage of school nurses [one nurse for every 2,200 students in California's public schools].
Dennis Maio, an attorney representing the diabetes association, said 26% of schools in California have no nurses, either part- or full-time. "Something's got to give," Maio said, especially since a child's need for insulin can be "unpredictable" at times....
May 29, 2013: The California State Supreme Court will hear arguments today in the American Nurses Association, et al. v. Tom Torlakson as Superintendent of Public Instruction, a case that, as reported by the American Diabetes Association, "disputes the legality of non-medical professionals administering insulin to children with diabetes in a school setting." The feds have already determined that "requiring only licensed medical personnel" to administer insulin interferes with federal disability laws (see history of this issue below).
As Howard Mintz reports in the San Jose Mercury News, the Court "will consider arguments from the [California Nurses Association] union, and other allies, including the [California Teachers Association] union, who contend that under state law, only [medically] licensed school employees can give insulin shots to children. ... in California's budget-battered education system...there's only one nurse for every 2,200 students. In the U.S., one in every 400 children and adolescents has diabetes.
June 1, 2011: The US Justice Department has stepped into the debate with a filing on May 18 with the California State Supreme Court, arguing that in the case of American Nurses Association vs. O'Connell Sl84583, the state law, requiring only licensed medical personnel (i.e., school nurses) to administer insulin to children with diabetes in public schools, interferes with federal disability laws, specifically that the law requires a school to provide "supportive services as may be required to assist a child with disability to benefit from special education."
The last court action, upholding the position of the Nurses Association, (see previous reporting after the jump) was in the state 3rd District Court of Appeals. The Nurses Association is supported by labor groups; the O'Connell (CA Dept of Education) side is supported by educators, and medical groups, including the American Diabetes Association, which is an intervenor appellant in the case; as well as various professional groups of pediatricians.
An article in SF Gate, by Bob Egelko, reports:
The Obama administration steered clear of the dispute over California law. It argued instead that restrictions on diabetics' access to insulin at school violate federal laws protecting the disabled from discrimination and guaranteeing them a "free, appropriate public education."
[Maureen] Cones, the nurses association's lawyer, said no U.S. court has ever ruled that federal disability laws override a state's authority over medical care and licensing. She said the main reason California schools don't have enough nurses [current ratio is one nurse for every 2,155 children; 7,000 public schools have no nurse at all] is that they're reluctant to spend the money to hire them.
Previously reported on this subject:
A California state appeals court decided [May 2010] to overturn California school regulations which currently allow trained staff members at public schools to give insulin shots to disabled children with diabetes. The decision is based on pre-existing state law, which requires the caregiver to be a nurse.
The ruling annuls an agreement between the state department of education and the American Diabetes Association that was reached in 2007 over concerns that California schools do not have enough nurses to properly care for children who are too young or unable to test their own blood sugar and inject insulin if necessary.
The suit was brought before the court by nurses’ organizations, citing state law which allows un-licensed medical personnel to administer insulin only in an emergency. The Third District Court of Appeal in Sacramento decided that the definition of emergency does not include the chronic shortage of nurses in California schools.
The current rule allowing non-nurse employees to give injections will remain in effect for 30 days, unless challenged in the state supreme court. Lawyers for state school officials stated that they are considering that type of appeal, and would also support legislation to change the law.