DIABETES SCHOOL CARE ACT AND CONNECTICUT LAW

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DIABETES SCHOOL CARE ACT AND CONNECTICUT LAW

cga.ct.gov

Topic:
DISEASES; LEGISLATION; MEDICAL CARE; SCHOOL PERSONNEL; SCHOOL BOARDS; SCHOOL DISTRICTS; STUDENTS; TRAINING PROGRAMS;
Location:
SCHOOL EMPLOYEES; SCHOOLS - HEALTH;


February 15, 2008
2008-R-0111

DIABETES SCHOOL CARE ACT AND CONNECTICUT LAW



By: Soncia Coleman, Associate Legislative Analyst


You wanted to know whether Connecticut has adopted legislation similar to the diabetes school care laws adopted in several other states.

SUMMARY

A number of states, including Texas, Indiana, and Utah, have adopted diabetes school care legislation, supported by the American Diabetes Association. The hallmarks of the legislation include requiring the establishment of a diabetes management and treatment plan, training school personnel who wish to volunteer as health aides to provide supplemental diabetes care, and allowing students the ability to monitor in the classroom.

The Connecticut legislature has not enacted the comprehensive diabetes school care legislation. However, in 2003, a new law, PA 03-211, prohibited school districts from preventing blood glucose self-testing by students. The act also required the education commissioner to develop related guidelines. Circular Letter C-19, issued on February 6, 2004, sets forth those guidelines, recommending that school district policies regarding self-monitoring of blood glucose levels in schools address a number of issues similar to the legislation in other states.

Below is a comparison of Connecticut's laws, regulations, and guidelines to the Indiana law, which appears to be both the most comprehensive and recently adopted (2007). The main differences appear to be that Connecticut's law and implementing guidelines do not allow students to self-test wherever they may be. They also do not contemplate volunteer health aides. Connecticut's provision on diabetes training does not appear to be as comprehensive as Indiana's. Finally, while Indiana's law is codified in a chapter entitled “Care of Students with Diabetes”, Connecticut's policies appear primarily in the form of guidelines that do not have the force of law and in statutes and regulations not specifically on the topic of diabetes.

The Connecticut Guidelines are attached for your use.

AUTHORIZED DIABETES MANAGEMENT AND TREATMENT ACTIVITIES

Indiana requires schools to allow students capable of managing and caring for their diabetes to do so. This includes allowing them to:

1. perform blood glucose level checks;

2. administer insulin through the insulin delivery system the student uses;

3. treat hypoglycemia and hyperglycemia;

4. possess the supplies or equipment necessary to monitor and care for their diabetes; and

5. otherwise attend to the management and care of their diabetes in the classroom, in any area of the school, on school grounds, or at any school related activity.

The school must establish a procedure by which the student is cared for in an emergency (IC § 20-34-5-17)

Connecticut provides that no local or regional board of education may prohibit blood glucose self-testing by children with diabetes who have a written order from a physician or an advanced practice registered nurse (APRN) stating the need and the capability of such children to conduct self-testing. The law also requires the education commissioner, in consultation with the public health commissioner, to develop guidelines for policies and practices with respect to blood glucose self-testing by children. However, these guidelines cannot be construed as regulations (CGS § 10-220j). The Connecticut Guidelines recommend that district policies address the appropriate location(s) for self-monitoring that take

into account individual student's needs, level of competence, health status, and independence. Therefore, unlike Indiana law, it is not presumed that students can test wherever they wish.

As for the administration of medication, such as insulin, Connecticut law provides that, a school nurse, or in her absence, any other licensed nurse, the school principal, any teacher, licensed school occupational or physical therapist, or school coach may administer medications to students at a school pursuant to the written order of a licensed physician, APRN, physician assistant, or dentist and with the written authorization of the child's parent or guardian. The law allows administration of all types of medications, including controlled substances. If medicine is administered by anyone other than the school nurse, it must be done under the nurse's general supervision. All of the authorized individuals have civil immunity for their actions relative to the administration of medication, with the exception of gross, willful or wanton negligence.

Each local and regional board of education that allows a school nurse or authorized individual to administer medicine or a student to self-administer medicine must adopt written policies and procedures, in accordance with regulations, that must be approved by the school medical advisor or other qualified licensed physician (§ 10-212a). The State Department of Education (SDE) has adopted detailed regulations covering administration of medicine in schools (see State Agency Regs. , §§ 10-212a-1 et seq. ). The regulations state explicitly that schools are not required to administer medicine to students. Local school boards may decide: (1) whether schools under their jurisdiction may give students medicine; (2) who may give the medicine (e. g. licensed personnel only or, in their absence, teachers and principals); and (3) whether students will be allowed to give themselves medication.

If a board chooses to allow the administration of medication, it must, with the advice of the school medical advisor and school nurse supervisor, establish specific written policies and procedures for doing so. The policies must be submitted to, and approved by, SDE. They must be reviewed and, if necessary revised, at least every two years. If the school nurse is absent, the regulations allow only school principals and teachers who are properly trained to give students medication. Such personnel may give oral, topical, or inhalant medicine and they may give injections only to students with medically diagnosed allergies that may require prompt treatment to protect against serious injury or death (State Agency Regs. § 10-212a-2).


Under the SDE regulations, a local board may allow a student to take medicine himself if:

1. the authorized prescriber gives a written order for self-administration;

2. the student's parent or guardian has given written permission;

3. the school nurse considers it safe and appropriate, documents her conclusion on the student's cumulative health record, and has a plan for general supervision;

4. the school principal and appropriate teachers are told the student is taking medicine himself; and

5. the student brings the medicine to school and keeps it in his control according to the school board's policy on student self-medication (State Agency Regs. § 10-212a-4).

DIABETES MANAGEMENT AND TREATMENT PLAN AND INDIVIDUALIZED HEALTH PLAN

Indiana law requires a diabetic student's parent and a licensed health care professional to prepare and implement a management and treatment plan for use during school hours or at a school-related activity. The plan must (1) identify the health care services or procedures the student should receive at school and (2) evaluate the student's ability to manage and understanding of the disease. The plan must be signed by both parties and submitted by the parent to the school nurse for review (IC § 20-34-5-12).

Indiana law also requires the school nurse to develop an individualized health plan, which incorporates the management and treatment plan, for each diabetic student while the student is at school or participating in a school activity. The nurse must develop the plan in collaboration with the principal, student's parent, one or more of the student's teachers, and, to the extent practicable, the student's health care practitioner (IC § 20-34-5-13).

The Connecticut Guidelines recognize that all students with diabetes need an individualized plan to address their health and safety needs in school settings. This plan may be a Section 504 accommodation plan or an Individualized Health Care Plan (IHCP) with an Emergency Care Plan (ECP). The State Board of Education recommends that district policies

regarding self-monitoring of blood glucose levels in school settings address, among other things, determining a process for developing and implementing an individualized plan for the student.

This includes identifying a core team to create the plan. This team should include, at a minimum, the school nurse; appropriate teacher(s); the student (if appropriate); and parent(s), guardian(s) or other family members. Other possible members include the student's health care provider, an administrator and other school staff. It also includes:

1. obtaining current health information from the family and the student's health care provider(s), including how often the child should monitor his or her blood glucose level;

2. based on the student's health status, determining the minimum frequency with which health information will be reviewed and updated; and

3. clarifying the roles and responsibilities of each member of the core team.

INFORMATION SHEET

Under Indiana law, a school must provide the individual who is responsible for providing transportation for or supervising a student with diabetes during an off-campus school related activity an information sheet that provides an emergency contact and identifies the student with diabetes, potential emergencies that may occur as a result of the diabetes, and appropriate responses (IC § 20-34-5-18).

The Connecticut guidelines provide that school policies should establish procedures ensuring that the appropriate people (including staff members such as teachers, custodians, bus drivers and substitute staff) are familiar with the 504 plan and/or IHCP and ECP, and are properly “educated” regarding diabetes and the importance of timely treatment.

HEALTH AIDES

Indiana law requires principals at each school that enrolls a diabetic student to, in consultation with the school nurse, seek school employees to serve as volunteer health aides and make efforts to ensure that the school has an adequate number of volunteer health aides to care for students (IC § 20-34-5-14).

Connecticut has no similar requirement although, as already noted, teachers, principals, coaches, and physical or occupational therapists can administer medication.

SCHOOL NURSES AND VOLUNTEER HEALTH AIDE DUTIES

Under Indiana law, the school nurse must perform the tasks necessary to assist a student in carrying out the student's individualized health plan. When necessary, a volunteer health aide may do so if the parent or legal guardian of the student signs an agreement that (1) authorizes a volunteer health aide to assist the student and (2) states that the parent or legal guardian understands that a volunteer health aide is not liable for civil damages for assisting in the student's care. The law prevents a school from restricting the assignment of a student to a particular school on the sole basis of whether the school has volunteer health aides (IC § 20-34-5-16).

Again, Connecticut law does not address volunteer health aides. According to regulation, the school nurses are responsible for the general supervision of the administration of medications in their schools (State Agency Regs. § 10-212a-7).

DIABETES TRAINING PROGRAM

Indiana law requires the provision of annual diabetes training programs to school nurses and volunteer health aides. The training must include technological advances, current standards of practice for diabetes management and training and instruction in certain specific areas. The school nurse must coordinate (1) the training of school employees acting as volunteer health aides and (2) record keeping and monitoring of a volunteer health aide. Training for volunteer health aides must be provided by a health care professional with expertise in the care of individuals with diabetes or by a school nurse. It must be provided before the beginning of the school year or as soon as practicable following the enrollment or the diagnosis of a student with diabetes at a school that previously had no students with diabetes (IC § 20-34-5-15).

While Connecticut does not have such a detailed requirement, the guidelines do recommend that district policies establish procedures ensuring that the appropriate people (including staff members such as

teachers, custodians, bus drivers, and substitute staff) are familiar with the 504 plan and/or IHCP and ECP, and are properly “educated” regarding diabetes and the importance of timely treatment.

This education should include: an understanding of diabetes; the signs and symptoms of high or low levels of blood glucose; familiarity with blood glucose equipment; appropriate location(s) for self-monitoring; possible adverse effects of high or low blood glucose levels on learning; and OSHA Universal Precaution standards. It should also include raising awareness of diabetes and the importance of blood glucose monitoring throughout the school, especially if monitoring is to occur in the classroom. However, individual student and family privacy needs and preferences should be considered.

Additionally, state regulations provide that each board of education which allows principals and teachers to give medications to students in the absence of a school nurse to provide training to designated principals and teachers in the safe administration of medications (State Agency Regs. § 10-212a-3).

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