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August 14, 2013
Editorial: On insulin, court sides with common sense


(Aug. 14 -- By the Editorial Board)

In an ideal public education system, there'd be a nurse in every school. But as the California Supreme Court acknowledged earlier this week and as the numbers show, California schools are far from perfect.

Here are some relevant numbers: California has 2,800 public school nurses, one for every 2,200 of 6 million public school students. Only 5 percent of the public schools have a full-time school nurse, and 26 percent have no nurse at all.

Here's another number that is especially important: 14,000. That's the number of public school students who have diabetes and may require insulin shots.

Unions and associations representing nurses in California and from across the country took the absolutist position before California's high court that only nurses could administer insulin injections.

But in a unanimous decision, the justices sided with the California Department of Education and the American Diabetes Association, and rebuked the American Nurses Association and other unions representing nurses.

The justices determined that properly trained volunteers at public schools are perfectly capable of administering insulin, so long as the children's physicians and parents authorize it.

Insulin is designed to be administered by non-health care providers, including children themselves.

Many nurses have sincere concerns that volunteers, no matter how well-trained, put children at risk. But by advocating that nurses exclusively administer insulin, nurses put schools in the position of having to hire more nurses. That's hardly a coincidence.

It also should be noted that nurses organizations are battling right now in the Legislature to expand their "scope of practice" over medical procedures. How can nurses take a rigid stand on administering insulin when they are criticizing physicians for their rigid opposition to expanding scope of practice?

In this case, parents of four diabetic children filed a federal lawsuit alleging that the Fremont and San Ramon Valley school districts failed to comply with federal law by not providing insulin for their children.

The California Department of Education sought a middle ground, authorizing voluntary school employees who are unlicensed but who have been trained to administer insulin. The American Nurses Association sued, leading to the high court's decision issued Monday.

The unanimous decision should put to rest any lingering doubts about whether properly trained volunteers can administer other medication, such as one used to combat epilepsy. Over the objection of the California Nurses Association, the Legislature approved a bill two years ago authorizing volunteers to administer the anti-seizure drug. Even now, some school districts balk at allowing volunteers to provide the anti-seizure medication, citing potential liability.

Every child deserves an education, including children who have conditions that require that medication be administered during school hours.

The U.S. Justice Department intervened in the California case, siding with the California Department of Education and American Diabetes Association that California law authorized volunteers to provide insulin.

Justice Department lawyers went a step further, arguing that if the California Supreme Court concluded otherwise, federal law would pre-empt state law and require that children be provided with medication.

The Supreme Court left that issue unresolved. Still, school administrators who continue to drag their feet ought to anticipate suits by parents citing state and federal law. Schools likely would lose, and rightly so.

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