Although the June 2010 ruling by the California state appeals court graced my desk nearly a month ago, I've needed time to calm down to put pen to paper (or should I say finger to key) and write about it. At the core of the issue is the fact that a labor group vying for power is using children in need of medical help as pawns to preserve it's territory, at whatever cost - even if this is at odds with what one of its core missions: to protect their charges' health.
The ruling overturned a 2007 regulation that allowed non-nursing yet trained school staff to administer insulin shots. This ruling is in favor of the American Nurses Association and The California Nurses Association, who assert that Type 1 children in the public schools are at risk if a trained school staffer, other than a nurse, administers insulin because insulin can be dangerous if given incorrectly and one needs substantial knowledge to give insulin injections without error.
(For the time being, we'll just overlook the fact that those managing diabetes and their caregivers need to make decisions about administering insulin on their own every day, and many of them are not trained as nurses.)
As you can guess from all of the news that's been coming out of California: the state is broke. Really, really broke. Everything is getting slashed in the state, and its public education system is feeling much of the cutting: teachers, admin staff, buses, and school nurses. There aren't enough nurses to go around, with those that are left traveling from school to school, and so there aren't enough nurses now needed to give Type 1 children the insulin injections that they need. The only people who can administer insulin are independent children, parents, or a relative/friend designated by the family.
Who Really Gets The Short End?
Where does that leave Type 1 kids in California? If the child is young, and let's say a kindergartner -- and still not yet ready (and nor should he be!) to take on all of the responsibility of the daily management of Type 1 - well, then that child is out of luck if there is no nurse at his school. No one is there that can legally administer insulin until a caregiver arrives. I cannot see how this is safe at all for a child who is suffering from hyperglycemia.
If you're an older child or teenager who is able to manage your diabetes independently, then life should continue on fairly normal. Unless, of course, the child needs someone to help out with an injection.
Families with Type 1 children are shortchanged too. This ruling more than likely will force a one of the child's parents to leave work just so that she or he can shuttle back and forth to the school for blood checks, carb counting and insulin injections. Around some of California's largest cities, traffic is a nightmare, which will be an increased burden on parents. Forget too, any other issues or demands that other family members may have.
But what about a single-parent family? If that parent stops working in order to take care of her child at school, who will pay the family's bills? Who will buy the needed insulin and other diabetes management supplies?
And so the vicious circle begins, and I feel a little like an overtired puppy chasing its tail. I'll never catch it and never understand whose trying to chase me.
I'm betting that the major insulin pump providers like Medtronic and Johnson and Johnson will see a huge upswing in their sales in California for this year. But insulin pumps are not without their issues: infusion sets need to be changed or get pulled out, and someone needs to be there to help out, often no matter what the child's age.
Not surprisingly, both the ADA and JDRF have issued statements in retaliation to the ruling. In particular, this ruling undermines the ADA's Safe At School Initiative.
Unfortunately, California is not the only state suffering from budget short falls that are impacting their schools. Watch out, a similar fate may hit a state near you.
For more info, see what Dr. Cogen has to say about the matter:
The Controversy of Diabetes Care in Schools
Published On: July 06, 2010