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 childrens diabetes care at school. What does the school diabetes care bill do? The bill supports New Yorks 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 nurses office to test their glucose, a task they could easily do anywhere. Such requirements can get in the way of the students 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 Programs 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 personnelcan 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 nurses 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 students 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 students parent or guardian, and as authorized by the childs 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 students 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 students 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 the Committee on Education AN ACT to amend the education law, in relation to care for with diabetes THE ASSEMBLY, DO ENACT AS FOLLOWS: 1 to 2 3 OR 4 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, SECONDARY SCHOOL SHALL ENSURE THAT ALL PUPILS WHO HAVE BEEN DIAGNOSED read as follows: S 921. CARE FOR PUPILS WITH DIABETES. 1. EACH ELEMENTARY, MIDDLE Section 1. The education law is amended by adding a new section 921 PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND pupils by M. of A. BENEDETTO -read once and referred to

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 PERFORM23 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 INSU5 LIN DELIVERY SYSTEM THE PUPIL USES; PROVIDING ORAL DIABETES MEDICATIONS; 6 AND FOLLOWING INSTRUCTIONS REGARDING MEALS, SNACKS, AND PHYSICAL ACTIV7 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. NOTWITH34 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 SUPER37 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.