Safe at School

California Supreme Court Victory Supports Access to Insulin for California Students

For nearly eight years, the American Diabetes Association fought in the courts to ensure that children with diabetes in California's public schools have access to the insulin they need to be safe at school.

On August 12, 2013, after two lawsuits, one landmark settlement and disappointing lower court decisions the California Supreme Court issued a ruling that vindicates the rights of these students. The Court held that California law permits school personnel to be trained to help students by administering insulin to those students who cannot self-administer in the absence of a school nurse.

What Does This Decision Mean?

The court's decision means that California schools will be able to meet the needs of their students with diabetes, and children will get the insulin they need quickly without having to wait for a school nurse.

Several nursing organizations insisted that school employees who are not nurses or other licensed health care professionals cannot safely administer insulin to a student with diabetes at school (no one disputed that parents, and family members or friends that they designate, can come to school to administer insulin, but they cannot be forced to do so). The families of children with diabetes and diabetes health care experts not only disagree with the idea that you need a health care license to administer insulin, but know that this position puts students with diabetes at risk. There is only one school nurse for every 2200 students in California and a budget crisis with school personnel being laid off across the state. And even if there was a full-time school nurse in every school, the nurse wouldn't be available for all extra-curricular activities and field trips.

We know that there is a better way: School employees who aren't nurses can raise their hand and offer to help. We know this works. Every day millions of doses of insulin are safely given by parents, siblings, family friends and babysitters—and by school employees in states from Washington to Florida. Diabetes experts including patient advocacy groups like the American Diabetes Association, JDRF and Children with Diabetes; government entities like the National Institutes of Health, Centers for Disease Control, and Department of Education; and health care professional societies all agree that insulin can—and should—be safely administered by trained non-medical school personnel when a nurse isn't available. What's standing in the way of safety and good sense? With this decision, the California Supreme Court removed any barrier that state law posed to allowing this solution to happen in the state's public schools.

How Did We Get Here?

Nearly eight years ago the American Diabetes Association, represented by Disability Rights Education and Defense Fund (DREDF) and Reed Smith LLP, sued the California Department of Education and several school districts because kids with diabetes weren't getting the care they needed. We successfully settled that case and the provisions included allowing a school employee who wasn't a nurse to volunteer to be trained to administer insulin when a nurse wasn't available.

So far so good.

Unfortunately, after the settlement was announced several nursing organizations (none of which specializes in diabetes) sued the California Department of Education arguing that under their interpretation of state law no one but a licensed health care professional can help a child with diabetes in need of insulin. The American Diabetes Association stepped in to fight for our kids.

The trial court and Court of Appeal disagreed with us, saying that state law ties their hands. They ruled that state law prohibits school employees who are not nurses from volunteering to help children with diabetes by administering needed insulin. It's worth noting that the judges didn't say that allowing school personnel to help out isn’t safe. In fact, two of the judges went out of their way to say that they think it's the right thing to do.

The American Diabetes Association asked the California Supreme Court to review this decision and, on September 29, 2010, the Court agreed. We asked the Court to reverse the decision of the lower court and hold that state law permits non-medical school staff to administer insulin and that federal law requires it where, as here, a nurse who isn’t there can't provide the needed care. In May 2011, a number of groups, including the U. S. Department of Justice, and medical groups including the American Academy of Pediatrics - Section on Endocrinology, the American Association of Clinical Endocrinologists, and the American Association of Diabetes Educators, filed friend of the court briefs supporting the Association's position. The case was argued before the Supreme Court on May 29, 2013 in San Francisco.

The Decision

On August 12, 2013, the Supreme Court agreed with our position and ruled that state law permits non-medical school staff to administer insulin when approved by the student's parent and treating physician, so long as the school personnel do not hold themselves out as nurses. (The Court did not address the issue of whether federal law would override state law.)

This decision is vital for California students with diabetes. It means they will no longer be placed in situations that engender their health, safety, and access to educational opportunities. Now, they will be able to receive insulin any time they need it, even if a nurse isn't there. It's also important for their parents, who will no longer face risking their child's health and safety every time they send a son or daughter to school, or have to quit their job or jeopardize their employment because of the constant need to provide care when a nurse is not available.

As a result of today's decision, not having a school nurse present will no longer mean children with diabetes have to sacrifice crucial diabetes care in California schools. The Court has recognized all children have the right to be safe at school.

For more information about diabetes care in California schools, click here.