Calif. Supreme Court Rules School Staffers Can Administer Rx Drugs
On Monday, the California Supreme Court unanimously ruled that trained, unlicensed school employees can administer insulin injections and other medications to children in public schools, the Los Angeles Times reports (Dolan, Los Angeles Times, 8/12).
The state's Nursing Practice Act prevents unlicensed individuals from performing the duties of a nurse, including providing treatment that requires significant scientific knowledge or technical skills. Under the law, administration of medicine is considered a nursing function.
Two lower courts have agreed with the California Nurses Association that only licensed nurses can administer insulin injections and other medications in public schools.
However, the American Diabetes Association appealed the decisions, citing a provision in the state law that allows any person to follow a physician's orders as long as that person does not assume the role of a nurse.
In May, the state Supreme Court heard arguments on the issue and evaluated the Nursing Practice Act alongside the state education code, which allows school personnel to assist students with medication (California Healthline, 5/31).
Details of Ruling
In a 26-page opinion, the justices wrote that the state education code "expressly" allows school employees who are not nurses to administer prescription medication (Walsh/Lambert, Sacramento Bee, 8/13).
The court noted that in California, there is one nurse per 2,200 students. In addition, the justices wrote that just 5% of state schools employ a full-time nurse, while 26% have no nurse on campus and 69% employ a part-time nurse.
"As a result, diabetic students have encountered difficulty in receiving insulin during the school day," the ruling states (Los Angeles Times, 8/12).
The court added that allowing unlicensed school employees to administer medication "reflects the practical reality that most insulin administered outside of hospitals and other clinical settings is in fact administered by laypersons."
The justices said that arguments by nursing groups "lack merit."
ADA, Schools' Reaction
Dennis Maio -- an attorney representing ADA -- said the association is "gratified" by the ruling.
"The bottom line of the law is that nobody can [administer a drug to a child at school], not even a nurse, without a physician's written order and written consent by a parent" Maio said, adding that those permissions "can be conferred on a duly trained, volunteer school employee."
Tom Torlakson -- the state superintendent of public education -- said, "[N]ot every student has access to a school nurse and, for some of them, that has been a very real obstacle to attending school and learning with their peers. I hope this decision removes that obstacle."
In a prepared statement, Karen Daley -- president of the American Nurses Association, which was involved in the case -- said the decision "lowers (the) level of care for children who are entitled to receive health care services at school and puts them at risk for medication errors that could have severe health consequences."
Daley also said that the ruling "sets a disturbing precedent for California and the nation" (Sacramento Bee, 8/13).
Maureen Cones -- an attorney for ANA -- called the ruling a "slippery slope," adding, "We don't want physical therapy given by the gym teacher, for example."
Cones said the nurses group is considering appealing the case to the U.S. Supreme Court (Carlton, Wall Street Journal, 8/12).
Headlines and links to broadcast coverage of the state Supreme Court's decision are provided below.
- "California Supreme Court: Trained School Employees May Administer Insulin" ("State of Health," KQED, 8/12).
- "California Supreme Court Rules in School Insulin Case" (Gibbons, "KXJZ News," Capital Public Radio, 8/12).
- "California Supreme Court: School Employees Can Give Students Insulin Shots" (Guzman-Lopez, "Pass Fail," KPCC, 8/12).