Is There an Insulin Pump in the Classroom?

How You Can Lower the Anxiety Level of the School Staff

| May 1, 2002

Are you planning to start your child on an insulin pump during summer vacation? While this may be a great time to get comfortable with a pump, the next challenge will come when the child returns to school.

What do the school nurse and the education staff of your child's school know about insulin pump therapy? What should you tell the school system?

School nurses and other personnel who will be in daily contact with the pump user should know how to recognize and manage emergency situations. They need to know basic facts about diabetes and basic facts about the insulin pump.

The key point: Communicate!

Educate the Staff

It's a good idea to provide fact sheets about the insulin pump and what to do if problems arise. Teachers, coaches, school bus drivers and any adults in contact with your child should know basic information about diabetes management and insulin pump management. They need this knowledge for the safety of your child.

If your child has acquired self-care management skills, give the school a list of the tasks that he or she can perform independently as well as those that require supervision or must be performed by a responsible adult. Be sure to get an extra copy of the pump user's manual and provide it for reference.

Diabetes educators who are experienced with insulin pump management can offer education sessions for the staff. The educator from the pump manufacturer can also provide this training. Animas, Disetronic and Medtronic/MiniMed can supply educational materials or reference booklets for the school staff (see sidebar on page 68). Many school districts also provide training days for district nurses. You may want to talk to your local representative about speaking at one of these.

Medical Appointments

If your child is starting a pump before school begins, you will have many follow-up visits to fine-tune blood-glucose control and pump management.

Set up appointments for these visits with the diabetes team before school starts. Ask them to give you copies of the child's diabetes regimen for the health records maintained at the school. Any changes in insulin therapy doses should also be given to the school health office. If the child is participating in team sports, you'll usually need a physical examination report.

New Prescriptions to School Nurse

Many schools require signed diabetes management orders for each school year, and many also have a specific form to be completed by the physician. Be sure to get a signed copy to give to the school nurse or health office.

Blood-Glucose Emergencies

Details about how to manage episodes of low and high blood glucose should be spelled out in the child's healthcare plan. This plan should also contain provisions for handling specific problems that might occur on field trips, during after-school activities and at other events away from the school location.

Recordkeeping

The school health office may have certain required forms and documentation standards. However, you might also be asked to provide blood-glucose records specific to insulin pump management. You might find it advantageous to use blood-glucose record forms approved by the diabetes team.

Supply Box

You'll want to keep a supply box at school that includes the following:

  • Snacks (fast-acting carbohydrates such as glucose tablets, glucose gel tubes, juice boxes or cans of non-diet soda pop)
  • An insulin pen or a vial of insulin
  • Insulin syringes
  • Glucose and ketone test strips
  • Instructions for treating both hypoglycemia and hyperglycemia

Pack or Purchase Lunch?

To help with carbohydrate counting, obtain copies of the school menu, and estimate the carbohydrate grams and meal bolus for each meal your child will be buying at school. It's easy to place this information into vinyl page protectors that can be inserted in a three-ring notebook. For lunches that you prepare and pack, you can write carbohydrate and bolus amounts on a 3x5 index card and place the card in the packed lunch (inside a clear sandwich bag or sealed food storage bag), or you can write the amounts on the outside of the lunch bag.

School Sports

Pack snacks for your child to eat before physical education class or sports activity, if needed. Consider a temporary reduction in your child's basal rate during physical activity or use an exercise basal program, if one has been established and approved by the diabetes team.

If your child is not skilled enough to make basal rate changes independently, identify and train a responsible adult to make these changes. Don't forget to update medical identification cards and jewelry.

Blood-Glucose Testing

Consider leaving an extra meter at school. It is one less thing for your child to remember to carry when rushing out the door in the morning.

Be sure to supply extra batteries and maintain fresh strips and control solutions. Provisions for disposal of medical waste (lancets and strips, for instance) vary by state; universal precautions for preventing infection and injury to others will apply. Check with the school health office for specifics.

Barbara A. Bradley, MS, RN, CDE, is a clinical manager for Animas Corporation in Frazer, Pennsylvania. n

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Categories: Adolescent Boys, Adolescent Girls, Blood Glucose, Diabetes, Diabetes, Food, Insulin, Insulin Pumps, Kids & Teens, Low Blood Sugar, Pens, Syringes


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Comments

Posted by advocate on 29 May 2009

this is a conspiracy by the school administrators, their lawyer and school nurse to deny my medically disabled son of his civil rights under the following:
Americans with Disabilities Act
I.D.E.A.
Civil Rights Act
C.A.P.T.A.
Constitution of the United States

it is ongoing and continual even with the federal dept of education office of civil rights lawsuit that is being investigated. They continue to break the law with intimidation and threats of discipline against my 14 year old son while he is in a Civil rights lawsuit.. They break state and federal law in doing so. Please stop them before my son goes into a diabetic coma because of their lies and abuse.

New Jersey

Child Abuse and Neglect

Physical Abuse
Citation: Ann. Stat. § 9:6-8.21



Please note; on 5/5/09 my son went to the nurse’s office with a blood sugar of 286. The nurse, Ms. Sandra Kowal, refused to allow him to medicate himself with a shot of insulin. She instead gave him a glass of water because, “that seems to work”! There is no place, no words, no indication within his medical plan that says “give water to bring blood sugars down”. She had him sit in her office for 1 ½ hours as his blood sugar climbed after her ‘water’ treatment to 460. She did not call me, my wife or my sons Dr during this blood sugar increase. An increase that could have been averted with an insulin shot when my son first entered her office (she left the office and came back after his first blood test, probably to go to Meloches office and discuss the withholding of medicine). She then called my sons Dr. and waited for a call back from the nurse in the Dr. office, who was in a meeting when Kowal called. As he approached 500 the Dr’s office called back and said he should have 12 units of insulin. A fact well known by the student, the nurse and all the Drs instructions on file with the school nurse. This action by the school nurse, the withholding of medicine as prescribed and directed by my sons Dr was purposeful and directed by the school administration. Just one more act of child abuse by an abusing and sick minded triumvirate of administrators who run our schools. The southern region of the State of New Jersey Department of Child and Welfare will be going to the school to investigate this egregious withholding of my sons medical needs as prescribed by and signed off upon by the school nurse.



The above action fits into several of the below child abuse laws, especially this one;





Physical Neglect



Refusal of health care—the failure to allow needed care in accordance with recommendations of a competent health care professional for illness, or medical condition.

Abused child or abused or neglected child means a child under age 18 whose parent, guardian, or other person having custody and control:

Inflicts or allows to be inflicted upon such child physical injury by other than accidental means that causes or creates a substantial risk of death [In people with diabetes, two conditions associated with very high blood glucose may cause coma; these are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state, considering the school holds the policy that is does not matter what blood sugar my son is, he still has to wait for the nurse or go to her, there are indeed circumstances that would CAUSE a substantial risk of death, including going into a coma while waiting or going into a coma on the way to the nurse and whacking his head on the floor or steps. (HHS).http://www.diabetesselfmanagement.com/articles/Diabetes_Definitions/Coma]



serious or protracted disfigurement, protracted impairment of physical or emotional health, or protracted loss or impairment of the function of any bodily organ.[Few people realize that stable blood sugar levels are one of the most important foundations of sound health. Over time, chronically high or heavily fluctuating blood sugar levels can inflict enormous hidden damage as the excess glucose combines with proteins, collagen, and enzymes, and reacts with cellular DNA. This can trigger serious negative long-term effects that can shave years or even decades off life (Cerami at al., 1987; Gillery et al., 1991). There policy will cause a 'protracted loss or impairment of the function of any bodily organ']



Creates or allows to be created a substantial or ongoing risk of physical injury to such child by other than accidental means [ the administration of Cherry Hill Schools refuses to allow my son to medicate as prescribed by his Dr., to wit, 'medicate immediately and without delay, no supervision is necessary', and in accordance with the state law on self medication shown above along with Ms. Kowals most recent actions. The previous statements above show the artificial creation of a substantial and ongoing risk of both short term and long term physical injury created by the administration and board of education]



Unreasonably inflicts or allows to be inflicted harm, or substantial risk thereof, including the infliction of excessive corporal punishment or by any other acts of a similarly serious nature requiring the aid of the court

[ Child abuse charges are being investigated and an Office of Civil Rights law suit is in progress ]

Child Abuse Prevention and Treatment Act (CAPTA) - the law (P.L. 93-247) that provides a foundation for a national definition of child abuse and neglect. Reauthorized in October 1996 (P.L. 104-235), it was up for re authorization at the time of publication. CAPTA defines child abuse and neglect as "at a minimum, any recent act or failure to act [the board of education has been fully aware of the fact that superintendent Campbell and principal Moloche are ignoring the law, medical needs and educational needs of my son, contrary to the board of educations policies and the medical treatment plan approved and signed by my sons Dr, the school nurse and my x wife which conform with state laws] on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm. [these risks have only been touched on above, like an iceberg tip, there are many more risks involved that are not notated here]



Physical Neglect

Refusal of health care—the failure to allow needed care in accordance with recommendations of a competent health care professional for illness, medical condition, or impairment. [ they are ignoring my sons Dr.s recommendations. He is the head of pediatric endocrinology at cooper hospital, i guess that would make him competent enough for this clause]

Other physical neglect—includes inadequate nutrition, clothing, or hygiene; conspicuous inattention to avoidable hazards in the home; and other forms of reckless disregard of the child's safety and welfare. [again, only slightly explained above, except for how they used to make him go to the nurses office even if he felt a low blood sugar, he arrived to the nurses office with a 48 glucose level, about 20 points under what most Type1 diabetics would pass out at. And again, they are in full knowledge of all the complications that arise from not treating this disease on an as needed basis and immediately so]



Spotlight on Chronic Neglect

One issue in defining child neglect involves consideration of "incidents" of neglect versus a pattern of behavior that indicates neglect. Susan J. Zuravin, from the University of Maryland at Baltimore School of Social Work, recommends that if some behaviors occur in a "chronic pattern," they should be considered neglectful. Examples include lack of supervision, inadequate hygiene, and failure to meet a child's educational needs. This suggests that rather than focusing on individual incidents that may or may not be classified as "neglectful," one should look at an accumulation of incidents that may together constitute neglect. "If CPS focuses only on the immediate allegation before them and not the pattern reflected in multiple referrals, then many neglected children will continue to be inappropriately excluded from the CPS system." For example, a family exhibiting a pattern of behavior that may constitute neglect might include frequent reports of not having enough food in the home or keeping older children home from school to watch younger children. In most CPS systems, however, the criteria for identifying neglect focuses on recent, discrete, verifiable incidents.

One study found that many children who had been referred to CPS for neglect did not receive services because their cases did not meet the criteria for "incidents" of neglect. It also found, however, that all of these children had, in fact, suffered severe developmental consequences . In recognition of this issue, the Missouri Division of Family Services (n.d.) has assigned one of its CPS staff as a "Chronic Neglect Specialist." This office defines chronic neglect as "…a persistent pattern of family functioning in which the caregiver has not sustained and/or met the basic needs of the children which results in harm to the child." The focus here is on the "accumulation of harm." CPS and community agencies across the country are recognizing the importance of early intervention and service provision to support families so that neglect does not become chronic or lead to other negative consequences.



Psychological Maltreatment

Terrorizing (e.g., threatening violence against a child, placing a child in a recognizably dangerous situation); [ as in, 'may i go to the nurse?' and then taking flights of stairs and walking empty hall ways feeling like he is about to tumble down on his head. as in him knowing that what they are making him do, under threat of reprisal, is both dangerous in the short term and deadly in the long term. sitting there and knowing..'i need a shot, i need a shot, i need a shot FOR THE DURATION OF THE CLASS. AND KNOWING WHAT NOT HAVING ONE IS DOING TO HIS EYES, HEART, CARDIO SYSTEM. ETC.]



Mental health, medical, and educational neglect (e.g., refusing to allow or failing to provide treatment for serious mental health or medical problems, ignoring the need for services for serious educational needs. [REFUSING TO ALLOW THE PRESCRIBED TREATMENT OF A SERIOUS MEDICAL PROBLEM, EDUCATIONAL NEGLECT....I HAVE HAD MY SON SELF TESTING AND MEDICATING, NOT AGAINST SCHOOL POLICY, BUT AGAINST CAMPBELL AND MELOCHE POLICY, SINCE JANUARY RESTART OF SCHOOL. IN MY SONS INTERIM REPORT CARD GRADES WERE A 'D' AND AN 'F'. IN THE 1/2 MARKING PERIOD HE HAD LEFT, HE BROUGHT BOTH THOSE GRADES UP, ONE TO AN 83, THE OTHER TO AN 84, BECAUSE HE STAYED IN CLASS AND KEPT HIS SUGARS IN CHECK BY ADMINISTERING HIS INSULIN AS NEEDED, AS PRESCRIBED BY HIS DR. HIGH BLOOD SUGARS ALSO MADE HIM UNABLE TO PAY ATTENTION IN CLASS. SO HIS CHOICES WERE, STAY IN THE CLASS AND ET NOTHING OUT OF IT, OR, LEAVE CLASS AND GO TO THE NURSE AND.......GET NOTHING OUT OF IT]



I HAVE LETTER AFTER LETTER FROM MOLACHE AND CAMPBELL WITH LIE AFTER LIE AS TO WHY THEY 'HAVE TO DO IT THIS WAY' AND HOW, 'THIS WILL MEET YOUR SONS MEDICAL NEEDS' WELL, NOT ACCORDING TO HIS DR IT DOESN'T. LIES THEY HAVE TOLD ME TO MAKE ME REALIZE THAT WHAT THEY ARE DOING IS NECESSARY AND LEGAL.



FEDERAL DEPARTMENT OF EDUCATION, OFFICE OF CIVIL RIGHTS

VS.

CHERRY HILL NEW JERSEY SCHOOL SYSTEMS



LAW SUIT



O.C.R. CASE # 02-09-1088



They have from the start, only looked for laws and guidelines to support the illegal treatment of my medically disabled son and not towards what his needs are, either medically or educationally for the long or short term. The students well being was never their concern. Protecting their precious policy was.

As each of the laws/guidelines trickled in, one or two at a time, I looked them up. I found them to be not only untrue, but to actually state the opposite of their claim for using them to block the student from testing and medicating in the classroom. As each copy of a law/guideline was sent back to them, as it was actually written and in most cases, with an interpretation of its use, they would send me another bogus claim to back up their policy. Each of those in turn, would also be refuted. Then we reached the wall. The wall where just this statement was repeatedly made by them, ’conforms to N.J. state law and guidelines’. When asked to furnish that law to me, on at least 7 different occasions in emails to their lawyer, Campbell and Meloche and another 5-8 times verbally over a 45 day period. Nothing. My x wife and I then go to our final meeting with Meloche at the end of February where he acts all innocent in saying, ‘I wasn't aware you requested it, I’ll get that to you’. One of several lies during that infamous, (referring to my sons glucose count) ‘even if his glucose level is 500 he has to wait for the nurse’ meeting. I forwarded to them copies of 6 requests I made in emails to them specifically asking for the law so they would know I had proof once again of their lying ways.

I am sure you have the copies now or will soon have from me those previous emails to them asking for the law they don't want share with us. By law, I am to be furnished with copies of laws that policy is based upon which effect my sons medical care. Not surprisingly, they again ignored the law and ignored my requests....repeatedly. That is, until the school lawyer sent me a copy of a law and guideline on March 5, 2009 that was already debunked in earlier attempts by them to justify their policy. A reiteration of a previously worn out and debunked claim by them. What a surprise. No wonder they didn’t want to send it to me.

The N.J.A.C. 6a:16-2.1, in which they want to include insulin medication and diabetics along with the epipen/inhalers and asthmatics listed in that passage. They will have to also include the insulin/diabetics in the self carry and administer as needed when needed of the so called ‘asthma law’ then too, that not only allows the use of medication IN AN EMERGENCY, but also to PREVENT THE ONSET OF AN EMERGENCY (hence the inhalers), which they say does not include insulin medication and diabetics because it is not specifically mentioned. Although my son is signed onto that law with the signature of the school nurse, my sons Dr. Post, and my x wife because he has, 'other life threatening illnesses', which is a clause within that law. They may not have it one way for one law where they read into it that diabetics are included, and another way for another law so it does, even with the inclusion of ‘other life threatening illnesses’, read it to exclude diabetics and only pertain to asthmatics. It is called continuity in policy. To say that insulin is not mentioned in the ‘asthma law’ so it does not pertain to my son, and then say that the N.J.A.C. 6a:16-2.1 is applicable when it does not say insulin is ridiculous. So again, they have no law/guideline to back up their child abuse of my son. And it is child abuse. I have included in this letter the N.J. child abuse laws along with their specific actions that demonstrate their willingly breaking those laws and in that breaking of the law, are indeed child abusers. I believe there are 11 instances of continual and ongoing child abuse issues. I can only judge their collective actions as bone headed, malicious, and aimed at an individual student. Yes, an individually targeted student. A 14 year old minor who they have called into administration offices on several occasions after the OCR complaint, to threaten with suspension and detentions for his god given act of self preservation of his life, eyes, heart, kidneys and extremities as ordered by, and within the guidelines of his Dr's orders to him. The administration was sent copied of these directives and hand delivered copies by me.....twice! These acts of intimidation are strictly forbidden by the civil rights act and are another example of the deliberate ignoring of the law by them. A law that once again, Meloche lied about, saying he didn't know about it, although he has been involved in other civil rights lawsuits ( that’s right, this is not their first time, it is their pattern), was emailed a copy of it from me (which I have in my sent box) and was also given a hard copy of that law. Meloche also lied and said he didn't know about a civil rights lawsuit. Although ONCE AGAIN, he was sent copies of the complaint and case number assigned to the complaint. And while I am on the subject of lies and Meloche, he said the Dr. orders weren't signed. He said it very fast to try and slip it under the rest of the conversation. I think that's called 'grasping at straws', since the copies are indeed signed. THE REST OF THE LIES THAT ARE CONTAINED IN REGULAR U.S. MAIL FROM THE SCHOOL TO ME. THEY ARE IN ORDER AND DATED. THEY ARE FROM MELOCHE AND CAMPBELL (Gallagher, who is in charge of Cherry Hill West being slick enough to keep a low profile and act behind the scenes throughout the proceedings, except for one, ‘fact finding’ meeting. The school nurse, Ms. Kowal, being intimidated enough BY THEM to forward everything I gave to her along with any questions I asked, her directly to Meloche, without comment to me, rather than to do her job as the students advocate and do her duty as it is outlined in the state school nurse guidelines and regulations).



PLEASE NOTE: THESE ARE ONLY THE REGULAR U.S. MAIL EXCERPTS AND NONE OF THE COPIOUS EMAILS I HAVE FROM THEM ARE INCLUDED HERE.



1) Re: O.S.H.A.- school statement starting with the nurse Ms. Kowal, prior to the start of school and reiterated in an enclosed copy of school district guidelines from Meloche on 10/20/08; as per the blood borne pathogens law by O.S.H.A. student must go to the nurse to check blood sugars.



1a) actually, the O.S.H.A. law specifically exempts the self testing and self medicating of employees and residents. Low and behold!!!! They even give DIABETICS as a specific example of that exemption.

Also, OSHA regulates employer/employee conduct, and does not apply to students in schools.

The landmark Diabetes Control and Complications Trials (DCCT) demonstrate that better glucose control significantly decreases the risk for long-term complications. For example, risk of diabetic eye disease was reduced by 76%; kidney disease by 50%; and nerve disease by 60%. The results were so striking that investigators ended the study early so conventionally treated patients could also realize the benefits of intensive diabetes management.





2) Re: school statement: N.J. Dept of Education Guidelines does not allow self testing in the classroom by students.



2b) Really? The N.J. Department of Education Task Force on Diabetes in the Classroom: Recommendations: The Task Force recommends that students be permitted to test blood glucose in school as per their IHP. For students requiring supervision, the blood glucose test should be performed in the nurse’s office and traditional lancets are suitable. For students who are deemed sufficiently responsible, mature, and knowledgeable to perform tests in the classroom. THIS GUIDELINE IS 19 YEARS OLD. YOU WOULD THINK THEY COULD HAVE AT LEAST GOTTEN SOMETHING THAT’S BEEN AROUND THAT LONG CORRECT.



3) The school nurse comes to the classroom to ' assist' the student in blood testing. 1/15/09

3a) Simply put, the medical confidentiality law is broken in doing this, just as it would be by her coming to observe his insulin shots in the classroom would do. It is also contrary to my sons medically prescribed directions to the school that he should take care of himself, ‘immediately and without delay’.



4) This is the ‘The Asthma Law’ which reads to include,’ medication by a pupil for asthma OR OTHER POTENTIALLY LIFE-THREATENING ILLNESSES.



P.L.1993, c.308 and supplementing chapter 40 of Title 18A of the New Jersey Statutes, Section 1 of P.L.1993, c.308 (C.18A:40-12.3)



C.18A:40-12.3 Self-administration of medication by pupil permitted.



1. a. A board of education or the governing board or chief school administrator of a nonpublic school shall permit the self-administration of medication by a pupil for asthma OR OTHER POTENTIALLY LIFE-THREATENING ILLNESSES.



THE SCHOOL SAYS THIS LAW ‘ONLY pertains to asthmatics because the improper dose of insulin compared to an epipen or nebulizer is a higher risk FOR THE DIABETIC’. Never mind what the law actually says, or that there is no mention in the law that says anything at all about any comparison of the two.



4a) the protocol for an epipen or nebulizer overdose is: call poison control and get the person to an emergency room immediately.

The protocol for an insulin overdose is: EAT SOME FOOD. By the way, a person who gives them self too much insulin knows well before any adverse reaction from that shot could effectually take place that they feel their blood sugar going down. The feeling of ' going low' is a body reaction and they would retest for a number and, 'eat food' to compensate the mistake, therefore avoiding any 'emergency' situation. While the epipen or nebulizer overdose comes on extremely fast and has no remedy to compensate the overdose at the students disposal. LET’S SEE, EAT SOME FOOD OR GO TO THE EMERGENCY ROOM AFTER CALLING POISON CONTROL. UMMM, I'LL TAKE THE EAT SOME FOOD OPTION WHILE I SIT IN CLASS AS THE LESSOR OF THE 2 EVILS.



5) ‘the school district is legally bound under applicable laws to monitor the students administration of medication’. They take this to mean that a nurse must be present when medication is done, AT LEAST FOR THIS ONE STUDENT.



5a) Guidelines for the self administration of medication say the student should let the nurse know what his numbers were and what actions were taken based upon those numbers, not that she must be witness to those actions, only be made aware of them. By the way, there is no place, no words, no indications or instructions in the students medical plan that say a nurse must be present for testing or medicating. As a matter of fact it says just the opposite! What a surprise, more reading comprehension problems by the administrators! The student is signed on to the provision in the asthma law that covers 'or other life threatening illnesses’, along with his Dr's. letters stating he does have a life threatening illness, is capable of handling his own testing and medicating and that it should be done immediately and without delay and that no other supervision is necessary (sounds like finding the nurse and having her find him is too long a process, especially since the school statement of, ‘no matter what his glucose number is he has to wait for the nurse, even if it is 500,’ is their policy) and that he does not need to wait for supervision since he is self sufficient in his OWN treatment, this being his 11th year with this disease.

Then, contrary to their illegal policy, they do not supply a nurse for after school activities so my son can comply with THEIR policy. Like my sons full season of football, or for Saturday school detentions and after school detentions. As far as sports, they say a trainer is there; their guidelines, according to them, supposedly say a nurse must be there, not a trainer. Even if a trainer was acceptable, his baseball practice is 3/4 of a mile from the trainer’s office in the school, and in a trainer’s room located where cell phone reception isn’t readily available most the time. There has been no trainer at away games. By the way, at a baseball meeting after school, the student had a blood sugar of 295 (enough for three grown ups), with no trainer or nurse available to 'facilitate' his much needed insulin shot. It was 3:30 p.m. I talked to a substitute nurse at 2:30 P.M. that day who knew nothing about a diabetic being at a baseball meeting. ALL administration officials were unavailable, as they were giving a tour to assistant principals ALL DAY LONG. I made no less than 10 calls throughout the day, starting at about 10:00 a.m., to Campbell, Gallagher and Meloche about having a nurse at the baseball meeting and at the Saturday school my son had the next day. I got a call from Meloche’s secretary at 2:30 P.M. saying to pick up the student at 10:30 A.M. instead of noon at the Saturday detention, a detention that starts at 8:00 A.M. No nurse would be there. Then at about 5:30 p.m., a screaming on the phone Joe Meloche said I had 2 options, go to the Saturday school or don’t!! When asked if my son would be suspended if he didn’t go, as previously threatened by Meloche, the two options were repeated a little louder. Several more "what ifs" on the same subjects were met with the same response by Meloche. By the way, the hours after breakfast, 8:00 a.m.-10:30 a.m. or so, are the time frame where high glucose is most likely to occur, especially in young adult males. This is due to our animal instinct of waking up ready to, 'go out and hunt'. Adrenalin and hormones release into the blood system to facilitate this ancient response in us and both effect blood glucose levels to the high end of the numbers, even when the prescribed dose of insulin is given at the time of eating breakfast. This goes for sporting activities too, although it is more of the ‘fight or flight’ body response of adrenalin that causes the increase in blood sugar. There is more on this Saturday school in the emails which make them look even more inept.



6) Same letter, same date 1/15/09: The district provides training to various staff members about diabetes.



6a) Well, I wish it was staff members who actually have contact with my son. Finally, at the beginning of March, 2 months after that letter, a staff meeting was held concerning diabetes. The first many of his teachers had heard of his condition. How do I know this? My son told me of the meeting after a teacher told him. Also, I had a call from a teacher, a Mr. Herman, back in December of 08, 4 months after school started. He was calling on behalf of several teachers who were concerned with my son not paying attention in class and fooling around. Both are signs of high glucose blood sugars and are very well know to be so. They should be easily recognizable to any one who has been instructed in diabetes. Mr. Herman was surprised when I told him my son was Type 1 diabetic and that these were symptoms of high blood sugars. Thanks for the, ‘training to various staff members’.



7) 1/21/09; the student is "REQUIRED TO ADMINISTER A DOSE OF INSULIN IN THE PRESENCE OF THE NURSE". 'This conforms with (sic) the current state of the law in new jersey and meets your sons needs to support his medical condition. If he does not adhere to these guidelines he will be subject to school discipline.' A case number was already assigned to my son’s Federal Department of Education Office of Civil Rights complaint, which I sent to the office of civil rights on 1/19/08. The school was made aware of the complaint and that it had been accepted and assigned a case number in an email I sent to them well before this incident.



7a-1) there is no law, state or otherwise, (none I could find, none the American Diabetes Association could find, none that special education lawyer Craig Becker could find and none the SCHOOL COULD FIND) that dictates a student MUST have a nurse present to administer insulin when they are already signed up with a medical plan that includes the provisions in the previously stated, 'asthma law' for students carrying and self administering to their own medical needs in an as needed way. As a matter of fact, the schools policy seems to be only for this individual student, both in the original and now debunked blood testing, which was stated as being district wide and is not, not even in the middle schools, and in insulin delivery, as other diabetics in the school have an insulin delivery system called ‘the pump’. The ‘pump’ administers a continual flow of insulin throughout the day. Do these students stand in the nurse’s office all day? As an admission of this fact, Meloche said we should have my son put on the, ’pump’. In his words,’ If you really care about your sons health’. Some how, I managed to remain seated. The, 'pump' is a personal choice determined between the physician and patient based on the activity level of the student and their willingness to wear a pump with all its drawbacks; like tubing and catheters hanging on them, along with the number of times a week it would have to be removed to allow for sporting activities. This student, my son, is not someone who qualifies for a pump under the current circumstances of his endeavors. This, ‘pump’ issue also mutes the schools stance on; carrying DEA controlled substances, (which insulin is not, as I called the DEA in Virginia and they don't give a crap about insulin, unlike how they do about epipen and nebulizer contents) and needles, as the pump is attached by one and epipens are just that, a needle delivery system. Just like my sons insulin delivery system is. A dial a dose pen with 3 locking needle covers. So while other kids are medicating for their diabetic needs and health throughout the day, absent of a nurses presence, and making adjustments to the insulin flow when the pump beeps to let them know to do so, my son is not allowed to do so.



7a-2) The school: our policy, ‘meets your sons needs to support his medical condition’. Really??? According to the students Dr., the head of pediatric endocrinology at Cooper Hospital in Camden, New Jersey, and as stated in his directions for the student’s health plan, the policy of the school DOES NOT MEET THE STUDENTS MEDICAL NEEDS. It is neither immediate nor without delay, it does not help forestall emergency situations and has the probability of putting the student in life threatening situations considering that the SCHOOL policy is," no matter what the students glucose number is, even if it is 500 ". This, by the way, is a NUMBER easily within the brain swelling, neurological damage and coma area. At that number, eye capillaries are exploding and are leading him down the path to blindness by scaring inside the eye. Considering, 'any number' means exactly that, I can only suppose that would go for 1,000 also. Call the coroner. All of this is being forced upon my son under the continued threatening and intimidation by the administration of suspension from school. That would make him ineligible for after school activities. This kid, my son, is the starting second baseman and lead off hitter on the National Championship 13 year old baseball team. He has been scouted by the University of Miami already. The administration knows baseball is his dream and have been told several times we worry about his eligibility because of the illegal disciplinary actions of the school. They are using this knowledge like a weapon against my son.

His disability has never been taken into consideration when he misbehaves in class (usually 1-3 period during the time he wasn't allowed to test himself for high sugars, the same classes he WAS doing poorly in grade wise, see the below comments) and after lunch, before the insulin, which could take up to 2 hours to fully activate had kicked in.

By law, disciplinary actions due to a disability are not allowed, (no teacher has ever asked him to check his glucose level to see if his actions could be disability related because of a high blood sugar, although I have given them permission to do so in an email). So their threats of detentions and suspensions, all after the filing of and notification to the school of the Federal Department of Education Office of Civil Rights case pending, are doubly threatening, as they would exclude him from sports participation until the suit is completed and they are forced to abide by the law.



8) Detention for late/tardy to school 1/26/09: 6 non excused lateness's. (These are prior to his being allowed to test himself in class)

8a) I personally went into the office each time he was late and explained it was because of a high blood sugar when he woke up. since he was NOT allowed to check himself to see where the number had been brought down to on a 15 minute schedule of checking to make sure the amount of insulin given was 1- bringing him down to normal levels and 2- not bringing him down PAST normal levels, nor would he be allowed to medicate further if the numbers continued to climb, I kept him home to monitor the glucose levels. I was told that without a Dr. note for each occurrence, it would be an unexcused lateness. Nice little pigeon hole to discipline him within. Follow the dangerous school policy or deal properly with his health and well being. As far a Dr. note, his medical file at school says, ‘immediately and without delay’, which as you can see, is unavailable at the school.



9) 2/11/09: again, another letter about conforming ‘with the current state of the law in new jersey’ and it, ‘meeting the students medical needs’. (Although they do not supply that law to me, since there isn’t one. I wonder if the wording of that, ‘with the current state of the law in new jersey’ is some slick way to get around actually saying ‘conforms with the current laws of the state’?)



10) 2/17/09: letter stating that the student is being disciplined for insubordination, medicating himself without the supervision of the nurse in, ‘violation of his current health plan’( which it doesn’t, since he has a signed medical plan to self medicate), and, ‘in clear violation of my (Meloche) directives to him and you (me)’(Absolute power corrupts absolutely). After school detention: incident# 7373, signed off on by Meloches scape goat, Asst. Principal Dunmore, who I went and talked to after receiving the detention notice. I brought the civil rights anti intimidation laws copy to her. She was livid and shot a look that could kill down to Meloches office area. By the way, Ms Dunmore is a diabetic also. I would like it if she could be kept out of any suit as she was kept out of the Meloche, Campbell, and Gallagher triumvirate loop until they had her put her name on the disciplinary action for medicating, without apprising her of the situation or the civil rights suit. Please note, this was done (the detention) a month after the case was taken by the civil rights dept and weeks after I had emailed, and after a hard copy was given to Meloche about the non intimidation laws of the civil rights division (probably why he handed it off to Ms. Dunmore to sign). First threats, and now action against the student, knowing all the time a suit was in progress and intimidation was forbidden. Laws mean nothing to these people unless it is their made up ones. By the way, I was told if this was a continuation, or if he had been disciplined previously for self medication before the suit, it might affect the intimidation clause. He was not, nor has he ever been, disciplined for self medication or blood glucose testing prior to the civil rights action being accepted. NEVER.



10a) there is nothing in his, ‘medical health plan’ that says he must go to the nurse or have her witness his shots. I have a copy of his plan given to me by the school and have read it many times. Zip. Nada. Nun ca. There is nothing about the nurse having to supervise his self-medication, but there is a signed agreement on self medication...the 'asthma law'.



11) 2/24/09: request for the school to contact the students Dr.



11a) Request denied by me. The schools continued lying, manipulation of the student, laws, and guidelines etc., lead me to believe that no good would come from them talking to, and then twisting what was said by the Dr., into a defense of their actions. The Dr has already weighed in on the proper treatment method to be followed for this student, and in no uncertain terms, has outlined exactly what the school should be doing to keep the student from accruing any, or limiting the effects, of his disease. The instructions are succinct, straight forward and have been issued 2 times to them. I could see no benefit coming from a manipulative administrations conversation with the Dr. I told them if they have any questions for him, ask them in court.



12) Same letter: they have instructed the staff of the school to block all emails from me because the emails are 'harassing'. Since no one blocked me, they have blocked my email name from the entire system, including the Carusi Middle School where my 12 year old daughter goes.



12a) I have only done the schools non performance of appraising the ' staff ' of the students medical condition, the results of a high blood sugar, gave them permission to ask the student to check glucose before writing up a disciplinary slip, made them aware of the civil rights suit, let them know about the non retaliation clause, let them know the student would be, against school policy, testing and medicating in their classroom, let them know that if they did NOT WANT any more emails from me, or wanted them to only be about classroom/student subjects, that I would immediately remove them from my email list, and I have done so with 2 teachers. One wanted no emails; the other wanted it limited to school specific questions/answers. DONE. I kept the rest updated on the administrations progress in resolving the situation and quoted what the administration had written or emailed to me and what the consequences of their policy would be on the student. FOR THIS, I HAVE BEEN RETALIATED AGAINST BY JOE MELOCHE ET AL by being told I must call before going to the school, even though i have always signed in at the front entrance, gotten a name tag with my destinations on it and logged into the visitor book, again with destinations listed. That I must stop in the office first and have them call Meloche and that all my discussions with any one in the school, nurse, teachers, administrators, must be done in Meloches office under his supervision. 1) I have never, except through emails, discussed my sons’ predicament with a teacher. The nurse I only went in person to drop off the ' diabetes medical plan' along with the reiteration letters from the Dr. and the school nurse guidelines on medical plans, that we want to put into action, a plan that was sent to schools lawyer, who is not part of the over site of the " medical home " instructions, only the medical home, the guardians/parent and school medical adviser and nurse are to make these plans, and the plan has not been seen or commented upon since. I have been instructed that even in an emergency to the student, that i must first stop in the office, explain to the office personnel exactly what the emergency is, and obtain permission from Meloche to act upon that emergency. I said the last place I would go to first is the office in an emergency situation. I have now been banned from the school grounds in their entirety, with threat of criminal action being taken should I show up. Isn’t this also considered intimidation?



13) if the school had a question concerning the law in regard to their policy, why was it necessary to also send the students medical records, without our permission, along to their lawyer. Doesn’t this break the medical confidentiality aspect of only letting people involved in his every day care and those he will be in contact with know of his condition? A question of law is just that, a law to be investigated, not a students medical history. Then, the lawyer takes one part of that medical record, letter 'b' of the care instructions, and says the Dr's only instructions are for testing and medicating once a day before lunch!!! How he just skipped over letter 'a' of the instructions is an incredible story I am dying to hear!! Letter 'a' says, "when ever he/she thinks it (blood glucose) is too high or too low or exhibits signs/symptoms of high or low blood sugars. Letter 'b' also includes, "please maintain a record of blood sugars and send it home weekly"... we have NEVER RECEIVED such a report from the school nurse for any week whatsoever.



Once again, the cherry picking, manipulation and lies of Cherry ‘Picking’ Hill. Do you wonder why I said no to them talking to the students Dr.?



14) Education: denial of equal education due to the illegal 'go to the nurse' policy. I have directed my son, since the January restart of school, to test himself and medicate himself in the classroom as needed to control his disease and he has done so. Although this was done in only the second half of the 2nd marking period, this simple, legal, medically recommended and common sense practice has resulted in his increasing his grades by a total of 38 points this marking period. A plus 8 in English, plus 13 in Algebra, plus 15 in Italian and plus 2 in World Civilizations. He took, again in just half a marking period, his interim grades of 'D' in Algebra to an 84, and an 'F' in Italian, to an 83.



15) Re: educational denial: his interim report for the 1st half of the 3rd marking period, during which time he has gone along with school policy so he would not be suspended and could play baseball. (Against my advice to him of capitulating to them at the expense of his grades and health my son now follows their policy. I guess the threats and intimidation from the administration have worked). His grades are down, markedly, again with an 'F' and a 'D' included. His class behavior is again, not acceptable and he has again, gotten a detention for it, without a glucose check to see if that’s what causing it.



Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. Section 1 of P.L.1993, c.308 (C.18A:40-12.3) is amended to read as follows:

C.18A:40-12.3 Self-administration of medication by pupil permitted)

http://www.special-ed-law.com/asthma_law.htm

Concerning the self administration of medicine by a student with a life threatening disease with certification from his/her Dr. that they are able to take care of themselves.



What the student does is legal. What the administration says he has to do is child abuse.

Posted by advocate on 29 May 2009

by the way, the 38 grade points he went up when he ignored their idiot and illegal policy were lost in the third marking period, he dropped 33 points from the test and medicate in class marking period. since baseball has ended, he went back to test and medicate in the classroom and his 4th marking period interim grades are 3 A's, 2 B's and C.


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