Update on Insulin & Diastat
November 23, 2009
The Honorable Darrell Steinberg, Senate President Pro Tem
The Honorable Karen Bass, Speaker of the Assembly
Members of the Legislature
Re: Administration of Insulin/Diastat by unlicensed, non-medical personnel
The California School Nurses Organization, California Teachers Association, California School Employees Association, American Nurses Association-California, California Nurses Association, California Labor Federation, United Nurses Association of CA-Union of Health Care Professionals and The Service Employees International Union-Nurses Alliance of California all strongly oppose any legislative effort to change the law to allow unlicensed, school personnel to administer Insulin and Diastat to our school children.
1) Insulin is a dangerous medication that must only be administered by licensed medical personnel. If you give too much insulin to a child, the child’s blood sugar level can drop dangerously low and cause the child to go into a diabetic coma. If insulin is administered incorrectly, it can also result in the child’s death. For all of these reasons, unlicensed school employees should not be administering insulin. They are not medical experts that are appropriately trained and licensed to administer this drug and to carefully evaluate the child, nor do they want to be put in a situation where a child could be injured by something they did.
2) Diastat (valium) is also a dangerous medication that must be administered rectally to control “cluster” or “breakthrough” seizures. There are many types of seizures so it is important to assess what type of episode the child is exhibiting. Diastat must be administered when a child is seizing. The rectal syringe is made of hard plastic so the possibility of piercing the rectal cavity is high. Because a seizure can happen at any moment, privacy for that seizing child is of upmost concern.
School Nurses and LVNs are trained to control the area, and provide appropriate care at a moment’s notice. There are adult and child dosages for Diastat. If the appropriate dosage is not given (for instance if the dosage is not properly locked in or the wrong syringe (adult) is administered) death due to respiratory failure can occur.
3)School employees face legal liability if something goes terribly wrong. School districts generally do not cover employees for punitive damages. When unlicensed school employees are multi-tasking and having to assume the duties of licensed medical professionals, there is always a risk that something will go terribly wrong.
4)The Legislature has already cut $18 billion from education in the last two budget cycles and thousands of school staff have been laid off. Employees are being asked to do more, with less. Unlicensed staff are being asked to perform these injections without being relieved of other duties. Also, funding for staff training is often the first to be eliminated. No funding will be provided to perform these duties and if training is provided, it will be inadequate.
The law requires that insulin be administered by competent health professionals, such as RNs, LVNs, and others for whom administering insulin to children in schools is within their existing scope of practice. We believe you have the responsibility to ensure the safety of our children and not to seek to weaken safety measures or advocate for a lesser standard of care than what is both needed and deserved. We cannot risk further erosion of our public education system and educational experience of our children. Our children are already bearing the brunt of far too many cutbacks. We urge legislators to avoid placing children in harm's way under pressure of political expediency. Schools must be properly staffed so that each child will receive a quality education and adequate health care.
Therefore it is imperative that schools, at the very minimum, maintain existing legal standards. We strongly support having licensed, appropriately trained health care personnel provide the high quality care that is required to assure that not only children with disabilities but all school children have access to a free, fair and appropriate education. We believe that weakening existing standards will have the unintended consequences of putting even more students at risk, especially minorities, the poor and the disenfranchised. We have a duty to equitably provide the highest standard of care to all, not just districts with vocal and educated parents.
Sincerely,
Nancy Spradling, CSNO
Dolores Duran-Flores, CSEA
Trisha Hunter, ANA-C
Toni Trigueiro, CTA
Stephanie Roberson, CNA
Caitlin Vega, California Labor Federation
Barbara Blake, RN, Secretary of UNAC
Ingela Dahlgren, RN, SEIU Nurse Alliance of California