Earlier this week, the California Supreme Court, in American Nurses Association v. Torlakson, ruled that trained school personnel who are not licensed health care providers may administer insulin to diabetic students. This case stemmed from a federal class action lawsuit filed by parents of diabetic students in the California public school system, along with the American Diabetes Association, against two named school districts and various state public education officials alleging that the school districts had failed to meet its obligations under the federal law to diabetic students by refusing to allow school personnel to administer insulin when school nurses were not available, thus requiring parents to come to school to administer insulin. Section 504 of the Rehabilitation Act (Sec 504) and the Individuals with Disabilities Education Act (IDEA) require school districts to administer insulin to students with diabetes as necessary with no cost to the student. School districts are responsible for developing Sec 504 plans or individualized education programs (IEPs) for qualifying students that detail a school district’s obligations to particular diabetic students.
The class action resulted in a 2007 settlement in which the state Department of Education agreed to release guidance to all school districts stating that school employees who are not licensed health care providers but have been trained to administer insulin may do so. The American Nurses Association filed a lawsuit in state court challenging the guidance as allowing the unauthorized practice of nursing under state law. Lower courts ruled for the American Nurses Association, but the California Supreme Court reversed in favor of the Department of Education. The Court found that the guidance did not in fact violate the state’s Nursing Practice Act, as the act expressly permits a layperson to carry out a physician’s medical orders for a patient, including administering prescription medications, and such would apply to school personnel with parental consent. The Court recognized that insulin is often administered by individuals who are not licensed health care providers, as some students are capable of administering insulin to themselves, and in other cases, insulin is administered by parents, friends, and relatives.
This decision, though not binding outside the state of California, has implications for students with medical issues and disabilities throughout the country. No state law may preempt the requirements of Sec 504 and the IDEA that students with diabetes, or any other medical condition, be given the treatment they need while at school, regardless of whether a school district employs enough school nurses to do so.
This issue came to light in Arkansas in 2011 when the General Assembly passed legislation specifically allowing the administration of glucagon, a medication used to raise low blood sugar in diabetic patients, by school employees to students in emergency situations. Various nursing groups opposed the legislation, arguing that only trained professionals were capable of administering such a medication. In the end though, the General Assembly sympathized with the parents of students who suffer from diabetes who testified that if their children didn’t receive an injection in time during an emergency, they could die, and with such a shortage of school nurses in Arkansas, chances were great that no nurse would be readily available during an emergency. School districts now have trained employees capable of administering the medication if necessary.