IMAGINE THAT you have a life-threatening medical condition that requires a critical procedure for you to survive.

Then imagine learning that the hospital, to save money, made a deal with your health plan to have this medically necessary procedure performed by unlicensed personnel in lieu of an actual doctor or nurse. Frightening scenario, isn't it?

Essentially, that's what the California Department of Education and the American Diabetes Association did when they struck an agreement allowing unlicensed staff members to provide insulin injections to schoolchildren with diabetes.

While they believed they had the best interest of the children at heart, the agreement, if left intact, could have very dangerous repercussions.

Thankfully, the California Superior Court overturned this agreement, recognizing that it ignored in place patient safeguards through the California Nursing Practice Act. That legislation specifies that only a licensed nurse or physician may administer medication in a school setting, with the following exceptions:

  • The student self-administers the medication.

  • A parent or parent designee, such as a relative or close friend not employed by the school district, administers the medication.

  • Or where there is a public disaster or epidemic.


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    California has more than 15,000 diabetic schoolchildren, many of whom require insulin to manage their disease. While some children have years of experience administering their own insulin, that is not the case for all. Those children who are incapable of treating themselves could have been at great risk and suffered irreparable harm had the agreement between the CDE and the ADA been allowed to stand.

    Insulin is considered a "high alert" medication. Meaning, if dosages are administered or calculated improperly, serious illness, coma or death can result. Insulin injections are considered to be so potentially dangerous that, even in a hospital setting, only a nurse can provide, and — even then — only after a second nurse has double-checked the dosage.

    Administering insulin is not as simple as dispensing a pill. It requires time and concentration. There are many factors to consider regarding insulin injections, including blood sugar levels, carbohydrate intake, time of day the last injection was taken, current activities (such as lunch or physical education), among many others. Students follow a personalized diabetes management plan, which includes when and what type of insulin they take, whether it will be taken by syringe, pen or pump and whether carbohydrates will be counted or corrected.

    A school wouldn't allow or consider using non-credentialed staff — secretaries, food services workers, janitors, instructional assistants — to teach students history, math, English, chemistry, health or a foreign language. Isn't it ironic that the CDE found it acceptable to allow unlicensed personnel to provide children with a medical procedure that can be life-threatening if a mistake is made?

    Safe and appropriate care of our students should be a priority. Parents should not have to settle for anything less and should demand, at the very least, that all school districts have at least one nurse available to ensure their children are receiving the best care possible.

    Dale Parent is president of the California School Nurses Organization.