The School Diabetes Care Bill (Senate Bill 4473/Assembly Bill 4987)

Background The care of most students with diabetes requires management throughout the school day. Diabetes

must be managed because high and low blood glucose (sugar) levels can be dangerous, and because

good management is needed to prevent the devastating long-term complications of diabetes,

including blindness, amputation, kidney failure and heart disease. Well-managed diabetes is also

crucial for the students’ ability to learn.

Necessary care by school staff includes monitoring of blood glucose levels and the administration of

insulin for students who are not yet able to perform self-care, and being available to provide

emergency care for all students with diabetes. Unfortunately, some families in New York are

encountering problems with their children’s diabetes care at school.

What does the school diabetes care bill do? The bill supports New York’s children with diabetes by allowing school staff to volunteer to be

trained to supplement the care provided by the school nurse. This way, the health and safety of the

student can be improved, and schools can fulfill their care obligations in the event a school nurse is

not available. The American Diabetes Association has prepared training materials that can be utilized

at no cost for this purpose.

The bill also ensures that students who are capable of self-managing their diabetes, be allowed to do

so with the permission of their parent and clinician. Self-management allows for responsive, timely

diabetes management. Too many students are required to leave class and go to the nurse’s office to

test their glucose, a task they could easily do anywhere. Such requirements can get in the way of the

student’s academic time in the classroom.

Are trained school staff necessary? While the school nurse has a central role in providing care for a student with diabetes, many schools

do not have a full-time nurse. Even when a nurse is assigned to a school full-time, he or she will not

always be available throughout the school day, during extracurricular activities, extended day, or on

field trips. Because diabetes management needs can arise at any time, other school staff should be

prepared to provide diabetes care. Although the ADA and health care professionals specializing in

diabetes support the central role of the school nurse, they also support training other school personnel

to provide this care (when a school nurse is not available) as the best – and safest – solution.1

1 Indeed, it is the overwhelming view of experts in the care of people with diabetes that the diabetes care tasks covered in this

legislation do not involve medical or nursing practice and can be safely and effectively accomplished by trained school

personnel. For instance, this conclusion is confirmed in the National Diabetes Education Program’s publication Helping the

Student with Diabetes Succeed: A Guide for School Personnel (2010). This guide, available at

http://ndep.nih.gov/media/youth_ndepschoolguide.pdf , is an authoritative guide on the care of students with diabetes, reflecting

the views of the primary diabetes, pediatric medicine, and educational organizations, and relevant government agencies including

the United States Department of Health and Human Services and Education. The Guide specifically recognizes and supports the

conclusion that “nonmedical personnel…can be trained and supervised by a diabetes-trained health care professional such as the

school nurse or a certified diabetes educator to safely provide and assist with diabetes care tasks in the school setting. These tasks

may include … insulin and glucagon administration…” The entities that have signed on to this guide include the Centers for

Disease Control and Prevention, National Institutes of Health, American Academy of Pediatrics, American Association of

Clinical Endocrinologists, American Association of Diabetes Educators, American Medical Association, and numerous other

medical organizations. For more information about the school diabetes care bill, contact Stephen Habbe at

shabbe@diabetes.org or (617) 482-4580 x3457.

Do other states allow this? Yes. Many states allow non-medical school staff to provide care and ensure that students may self-manage their diabetes outside of the nurse’s office. Approximately 30 states have adopted legislation and/or regulations specifically involving the care of students with

diabetes at school. And right here in New York, non-medical staff in day care settings are already allowed to provide diabetes care.

Section by Section Summary of the New York School Diabetes Care Bill (Senate Bill 4473/Assembly Bill 4987)

Section 1

(1) Students with diabetes shall receive diabetes care as specified in their Diabetes Medical Management Plan, which is developed by the student’s health care provider and sets out the health services needed by the child during the school day to remain healthy and safe.

(2) Upon the request of the student’s parent or guardian, and as authorized by the child’s Diabetes Medical Management Plan, the student shall be allowed to perform blood glucose checks, administer insulin through an insulin delivery system, treat hypoglycemia and hyperglycemia, and otherwise attend to the care and management of her or her diabetes when and where necessary, and to possess all necessary equipment and supplies to do so.

(3) Upon the request of the student’s parent or guardian and authorization of the Diabetes Medical Management Plan, trained diabetes personnel may perform diabetes care functions.

(4) Trained diabetes personnel are volunteers who have completed diabetes care training. They need not be a health care provider, and they are permitted to provide diabetes care for which they have been trained. School employees shall not be subject to a penalty or disciplinary action for refusing to serve as trained diabetes personnel.

(5) The Commissioner of Education, in conjunction with the Commissioner of Health and other interested parties, shall develop training guidelines for the training of school employees in the care needed for students with diabetes. Training shall be provided by a licensed health care professional, and training and supervision of such school employees shall be lawful.

(6) No licensed health care professional or school employee shall be subject to disciplinary action under professional licensing regulations or school disciplinary policies as a result of the activities authorized by this legislation. School personnel shall receive the protections from liability for civil damages provided by section 3000a of the public health law.

(7) A school may not restrict a student with diabetes from attending a school on the basis of the student’s diabetes or the lack of personnel to provide care.

Section 2. This act shall take effect one year after it shall have become a law. The Commissioner of Education may promulgate any rules or regulations necessary.

S T A T E O F N E W Y O R K

________________________________________________________________________

4987

2013-2014 Regular Sessions

I N A S S E M B L Y

February 14, 2013

___________

Introduced by M. of A. BENEDETTO -- read once and referred to

the

Committee on Education

AN ACT to amend the education law, in relation to care for pupils

with

diabetes

THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND

ASSEM-

BLY, DO ENACT AS FOLLOWS:

1 Section 1. The education law is amended by adding a new section 921

to

2 read as follows:

3 S 921. CARE FOR PUPILS WITH DIABETES. 1. EACH ELEMENTARY, MIDDLE

OR

4 SECONDARY SCHOOL SHALL ENSURE THAT ALL PUPILS WHO HAVE BEEN DIAGNOSED

BY

5 A PHYSICIAN OR OTHER DULY AUTHORIZED HEALTH CARE PROVIDER WITH

DIABETES

6 RECEIVE APPROPRIATE AND NEEDED DIABETES CARE AS SPECIFIED IN

THE

7 DIABETES MEDICAL MANAGEMENT PLAN SUBMITTED BY THE PARENT OR GUARDIAN

OF

8 SUCH PUPILS WITH DIABETES. FOR THE PURPOSES OF THIS ARTICLE,

"DIABETES

9 MEDICAL MANAGEMENT PLAN" SHALL MEAN A DOCUMENT DEVELOPED BY A

PUPIL'S

10 PHYSICIAN OR OTHER DULY AUTHORIZED HEALTH CARE PROVIDER THAT SETS

OUT

11 THE HEALTH SERVICES NEEDED BY THE PUPIL WHILE AT SCHOOL AND IS SIGNED

BY

12 THE PUPIL'S PHYSICIAN OR OTHER DULY AUTHORIZED HEALTH CARE PROVIDER

AND

13 PARENT OR GUARDIAN.

14 2. UPON WRITTEN REQUEST OF THE PARENT OR GUARDIAN AND AUTHORIZATION

BY

15 THE PUPIL'S DIABETES MEDICAL MANAGEMENT PLAN, EACH ELEMENTARY, MIDDLE

OR

16 SECONDARY SCHOOL SHALL ALLOW PUPILS WITH DIABETES TO PERFORM

BLOOD

17 GLUCOSE CHECKS, ADMINISTER INSULIN THROUGH AN INSULIN DELIVERY

SYSTEM,

18 TREAT HYPOGLYCEMIA AND HYPERGLYCEMIA, AND OTHERWISE ATTEND TO THE

CARE

19 AND MANAGEMENT OF HIS OR HER DIABETES IN THE CLASSROOM, IN ANY AREA

OF

20 THE SCHOOL OR SCHOOL GROUNDS, AND AT ANY SCHOOL-RELATED ACTIVITY, AND

TO

21 POSSESS AT ALL TIMES ALL NECESSARY SUPPLIES AND EQUIPMENT TO

PERFORM

22 SUCH FUNCTIONS. PUPILS SHALL HAVE ACCESS TO A PRIVATE AREA FOR

PERFORM-

23 ING DIABETES CARE TASKS IF THE PARENT OR PUPIL REQUESTS ONE.

24 3. UPON WRITTEN REQUEST OF THE PARENT OR GUARDIAN AND AUTHORIZATION

BY

25 THE PUPIL'S DIABETES MEDICAL MANAGEMENT PLAN, TRAINED DIABETES

CARE

26 PERSONNEL, AS DEFINED IN SUBDIVISION FOUR OF THIS SECTION, MAY

PERFORM

27 DIABETES CARE FUNCTIONS INCLUDING, BUT NOT LIMITED TO: CHECKING

AND

28 RECORDING BLOOD GLUCOSE LEVELS AND KETONE LEVELS OR ASSISTING A

PUPIL

EXPLANATION--Matter in ITALICS (underscored) is new; matter in

brackets

[ ] is old law to be omitted.

LBD08865-01-3

A. 4987 2

1 WITH SUCH CHECKING AND RECORDING SUCH LEVELS; RESPONDING TO

BLOOD

2 GLUCOSE LEVELS THAT ARE OUTSIDE THE PUPIL'S TARGET RANGE;

ADMINISTERING

3 GLUCAGON AND OTHER EMERGENCY TREATMENTS, AS PRESCRIBED;

ADMINISTERING

4 INSULIN OR ASSISTING A PUPIL IN ADMINISTERING INSULIN THROUGH THE

INSU-

5 LIN DELIVERY SYSTEM THE PUPIL USES; PROVIDING ORAL DIABETES

MEDICATIONS;

6 AND FOLLOWING INSTRUCTIONS REGARDING MEALS, SNACKS, AND PHYSICAL

ACTIV-

7 ITY.

8 4. FOR THE PURPOSES OF THIS SECTION, "TRAINED DIABETES CARE

PERSONNEL"

9 SHALL MEAN SCHOOL PERSONNEL WHO VOLUNTEER TO BE TRAINED IN THE

CARE

10 NEEDED FOR PUPILS WITH DIABETES AND WHO COMPLETE TRAINING PURSUANT

TO

11 SUBDIVISION FIVE OF THIS SECTION. TRAINED DIABETES CARE PERSONNEL

NEED

12 NOT BE LICENSED HEALTH CARE PROVIDERS. NOTWITHSTANDING ANY

OTHER

13 PROVISION OF LAW, THE ACTIVITIES OF TRAINED DIABETES CARE PERSONNEL

SET

14 FORTH IN SUBDIVISION THREE OF THIS SECTION SHALL NOT CONSTITUTE

THE

15 PRACTICE OF NURSING AND SHALL BE EXEMPTED FROM ALL APPLICABLE

STATUTORY

16 AND/OR REGULATORY PROVISIONS THAT RESTRICT THE ACTIVITIES THAT CAN

BE

17 PERFORMED BY A PERSON WHO IS NOT A LICENSED HEALTH CARE

PROFESSIONAL.

18 SCHOOL PERSONNEL SHALL NOT BE SUBJECT TO ANY PENALTY OR

DISCIPLINARY

19 ACTION FOR REFUSING TO SERVE AS TRAINED DIABETES CARE PERSONNEL,

NOR

20 SHALL A SCHOOL OR SCHOOL DISTRICT DISCOURAGE SCHOOL PERSONNEL

FROM

21 VOLUNTEERING FOR TRAINING.

22 5. NO LATER THAN ONE HUNDRED EIGHTY DAYS FROM THE EFFECTIVE DATE

OF

23 THIS SECTION, THE COMMISSIONER IN CONSULTATION WITH THE COMMISSIONER

OF

24 HEALTH, SHALL PROMULGATE FINAL REGULATIONS WITH THE GUIDELINES

FOR

25 TRAINING SCHOOL PERSONNEL IN THE CARE NEEDED FOR PUPILS WITH

DIABETES.

26 THE GUIDELINES SHALL BE DEVELOPED IN CONSULTATION WITH STATE

AND

27 NATIONALLY RECOGNIZED ORGANIZATIONS WITH EXPERTISE IN THE CARE OF

PEOPLE

28 WITH DIABETES AND IN THE TRAINING THEREOF INCLUDING, BUT NOT LIMITED

TO,

29 THE AMERICAN DIABETES ASSOCIATION, THE AMERICAN ASSOCIATION OF

DIABETES

30 EDUCATORS, AND THE NEW YORK STATE ASSOCIATION OF SCHOOL NURSES.

THE

31 TRAINING SHALL BE COORDINATED BY THE SCHOOL PRINCIPAL OR THE

PRINCIPAL'S

32 DESIGNEE, AND SHALL BE PROVIDED BY A SCHOOL NURSE AND/OR

ANOTHER

33 LICENSED HEALTH CARE PROFESSIONAL WITH EXPERTISE IN DIABETES.

NOTWITH-

34 STANDING ANY OTHER PROVISION OF LAW, IT SHALL BE LAWFUL FOR A

LICENSED

35 HEALTH CARE PROFESSIONAL TO PROVIDE TRAINING TO SCHOOL PERSONNEL IN

THE

36 ACTIVITIES SET FORTH IN SUBDIVISION THREE OF THIS SECTION OR TO

SUPER-

37 VISE SUCH SCHOOL PERSONNEL IN PERFORMING THESE TASKS.

38 6. NO LICENSED HEALTH CARE PROFESSIONAL OR SCHOOL PERSONNEL SHALL

BE

39 SUBJECT TO DISCIPLINARY ACTION UNDER PROFESSIONAL LICENSING

REGULATIONS

40 OR SCHOOL DISCIPLINARY POLICIES AS A RESULT OF TRAINING AND

PERFORMANCE

41 OF DIABETES CARE TASKS BY TRAINED DIABETES PERSONNEL AUTHORIZED BY

THIS

42 LEGISLATION. A LICENSED HEALTH CARE PROFESSIONAL, SCHOOL PERSONNEL

OR

43 ELEMENTARY, MIDDLE OR SECONDARY SCHOOL SHALL BE PROTECTED FROM

LIABILITY

44 FOR CIVIL DAMAGES AS PROVIDED IN SECTION THREE THOUSAND-A OF THE

PUBLIC

45 HEALTH LAW WHEN PERFORMING THE ACTIVITIES DESCRIBED BY THIS SECTION.

46 7. AN ELEMENTARY, MIDDLE OR SECONDARY SCHOOL OR SCHOOL DISTRICT

MAY

47 NOT RESTRICT A STUDENT WHO HAS DIABETES FROM ATTENDING ANY SCHOOL ON

THE

48 BASIS THAT THE STUDENT HAS DIABETES, THAT THE SCHOOL DOES NOT HAVE

A

49 FULL-TIME SCHOOL NURSE, OR THAT THE SCHOOL DOES NOT HAVE

TRAINED

50 DIABETES CARE PERSONNEL.

51 S 2. This act shall take effect on the three hundred sixty-fifth

day

52 after it shall have become a law; provided, however, that

effective

53 immediately, the commissioner of education may promulgate any rules

or

54 regulations necessary for the timely implementation of this act on

or

55 after such effective date.