Court Sides With California Nurses, Rules That Only They Can Give Insulin Shots to Diabetic Kids

Nov 24, 2008

A Superior Court judge in Sacramento has overturned a 2007 ruling that allowed trained school staff, not just registered nurses, to administer insulin shots to children with diabetes. The ruling affects approximately 14,000 California school children. 

Several nursing groups, including the California School Nurses Organization, the American Nurses Association, and the California Nurses Association, had brought suit against a 2007 directive by the California Department of Education (CDE) that allowed unlicensed school staff members to administer insulin shots if a parent or nurse were not available.

The CDE had issued the directive after settling a 2005 class-action lawsuit lodged by parents of children with diabetes and the American Diabetes Association. 

In that suit, the plaintiffs alleged that because of a shortage of nurses in the state's public schools, many parents were forced to miss work or keep their children out of school in order to give them shots.

Only approximately 2,800 nurses are available for the state's 9,800 public schools.

The suit alleged that forcing parents and children into inconvenient injection schedules violated federal law by denying children the level of care mandated for children with disabilities.

But nurses protested that the directive violated state laws that forbid the administration of injections by anyone other than trained nurses. 

Superior Court Judge Lloyd Connelly agreed, voiding the agreement reached between the CDE and ADA last year.

Although nurses are now the only ones permitted to inject schoolchildren with insulin, there are three exceptions:

  1. When students are qualified to administer injections to themselves.
  2. When a parent or a person designated by a parent (who is not a school district employee) administers the injection.
  3. When there is an epidemic or public disaster that affects the availability of nurses.

Editor's note: Diabetes Health will continue to monitor this topic. The ruling leaves it up to the state's school districts to find money to hire the nurses necessary to administer insulin at convenient times during the school day. We know the ruling is a huge burden on parents in California. How has the ruling affected you and your family? Please let us know by posting your comments below.

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Categories: Diabetes, Diabetes, Government & Policy, Health Care, Insulin

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Posted by shosty on 25 November 2008

This is a terrible ruling, and should not last, because it is discriminatory and violates the rights of kids with diabetes, and their parents. Whether insulin or glucagon, lay staff need to be able to administer medications to kids with diabetes,to ensure their full participation in school.

Our school in Massachusetts took this stance, that only nurses could do injections, and I could not work for many years, so that our daughter could get the care she needed. Administering the shots is not the hard part. The hard part is figuring out the dose, and making adjustments to the dose depending on variables like exercise, illness, hormones, stress, and so on.

Even though our school had a nurse, she could not make adjustments to doses. Our school went so far as to purchase cell phones, and, if our daughter was high or low, the nurse called me, then I was supposed to call my daughter (or she called me) to give her the dose. Then, our daughter gave herself the shot. Needless to say, my day consisted of many calls, and I could not work. I was, of course, unpaid while I did this work for the school.

So, nurses out there, what is the point of having a nurse?

The best year we had was when there was an aide for the two kids with diabetes. The aid was available at all times, and communicated with me if needed. But, because she was not bound by licensure and nursing regs., this aide even made some decisions.

The nurse, to protect her license, called me every hour for years. The aide, on the other hand, told me "go out and Christmas shop and don't worry, I'll take care of things."

Parents, get ready for bondage in CA.

One other thing, and that is the use of "convenient" or "convenience" in this article, twice. This may be referring to scheduled shots, for those who rely on shots for diabetes management.

However, for those on pumps, as well as those on shots, many of the injections necessary are not scheduled. Instead, they are correction responses to high blood sugars. This response needs to be immediate, in order to bring the child back into a safe range, avoid complications in the future (a high for more than 2 hours damages the body),and avoid the cognitive problems and physical discomfort that a high of a few hours can bring. Correction doses are not administered at "convenient times," but asap, and can be needed at any time of the day, not just the hours when a nurse might be there.

When our nurse was at meetings, and our daughter was little, I ran over to school to do shots, because it was a horrible thought that she would have to sit there with a blood sugar over 250, waiting for the nurse to get out of a meeting. And this was at a school with a nurse!

The court in CA needs more education on tight control and its beneficial effects on children's health and learning. If the state cannot hire a nurse for every school, this ruling violates the students' rights.

But I caution everyone, that even more needs to be done. Having a nurse certainly did not guarantee our child care at school.

Posted by Anonymous on 25 November 2008

What about eppei pens will they be required to have an R.N. administer them??

Posted by Anonymous on 25 November 2008

Welcome to the Washington State way of doing diabetes! Registered nurses are the only people allowed to give insulin shots and administer glucagon. Our nurse is only at the school on Tuesdays! Not much help! I am sorry that California has taken this stance. It will be tough on the parents. I must run to the school every day at lunch to administer insulin. If I am sick or must be somewhere else, my husband has to take time off from work. We both do what we must to keep him in control and healthy!

Posted by Anonymous on 25 November 2008

It is to be expected in a State where government is constantly hijacked by labor union lobbies.

Posted by Anonymous on 25 November 2008

Hi, Washington state anonymous. I'm another Washington state anonymous, and I just sent off an email to my state legislators urging them to rectify this situation. It is ridiculous that parents should have to be at the school's beck and call every single day in order to prevent their children from experiencing a medical disaster. The fact that other responsible adults are not trained and authorized to administer glucagon shots really alarms me, because you only administer those in an emergency. I urge all Washingtonians who read this to write to their state legislators; let's see if we can get this law changed.

Posted by Anonymous on 25 November 2008

California has something like a $22 billion state deficit this year and services are being cut everywhere while taxes are rising to crushing levels simultaneously. Yet now this. How, exactly, do the proponents of this policy propose to pay for these thousands of additional school nurses that this will require? Everybody wants yet nobody wants to to pay. This will be our country's downfall.

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