1. Does New York allow people who are not health care professionals to administer insulin at school?
No. However, school staff members who are not licensed health professionals can do some limited diabetes care for students with insulin pumps. These staff members may verify the accuracy of students' math calculations for carbohydrate counting, and make sure the student puts in the intended numbers. However, guidance from the New York Department of Education states that only licensed health professionals can actually administer the insulin:
Licensed health professionals are the only school personnel permitted to calculate insulin dosages, administer insulin, program the insulin pump, refill the reservoir, and change the infusion site because these are a component of medication administration. Unlicensed personnel are not permitted to perform these functions. […] Unlicensed school personnel trained by a licensed health professional may assist a self-directed student in programming their own pump by either verifying the accuracy of the student's math in calculating their own carbohydrate count; or by reading the pump screen to the student verifying the number input is the number the student intended to input. [...] The calculation of an insulin dose based on the blood glucose reading cannot be done by unlicensed school personnel and must be calculated by a licensed health professional. NYSDE, "Clarification on Insulin Pumps," (Mar. 20, 2012) (pdf) (emphasis in original).
Regardless, federal laws may allow unlicensed staff to provide care when a nurse is not available. This may be necessary so that children with diabetes can access education just like any other child.
2. Does New York allow people who are not health care professionals to administer glucagon at school?
Yes. Unlicensed staff in both public and private schools can be trained to administer glucagon when a nurse is not present:
The board of each school district and board of cooperative educational services and nonpublic schools are authorized, but not required to […] train unlicensed school personnel to administer prescribed glucagon in emergency situations where an appropriately licensed health care professional is not available […] Training by the licensed health professional is to be provided in a competent manner. 8 NYCRR § 136.7 136.7 (d)(7), accord NY Consolidated Law Service Educ § 921 (2015).
3. Does New York allow students to self-manage diabetes care anytime, anywhere?
Yes. New York specifically requires schools to allow students to test blood glucose and perform other diabetes care at school and at school functions:
The Board of Education or Trustees of each school district and Board of Cooperative Educational Services shall allow pupils who have been diagnosed with diabetes to carry glucagon and carry and use insulin through appropriate medication delivery devices and equipment and/or to carry and use equipment and supplies necessary to check blood glucose levels and ketone levels, as prescribed by a physician and other duly authorized healthcare provider, during the school day on school property and at any school function […] with parental consent and the written permission of a physician or other duly authorized health care provider. […] Pupils with diabetes may also carry any food necessary to treat hypoglycemia […] NY Consolidated Law Service Educ §916-b (2015).
On August 5, 2021, the Governor signed SB 1239 (2021–2022 Legislative Session), authorizing trained unlicensed school personnel to administer prescribed glucagon (injectable and nasal) to students with authorization from the student’s provider.
4. Does New York allow students to carry diabetes supplies such as needles, insulin, and blood glucose testing devices anytime and anywhere?
Yes. As stated above, students with permission from parents and a medical provider may self-administer and self-carry "equipment and supplies" for all types of diabetes, including carrying "food necessary to treat hypoglycemia." NY Consolidated Law Service Educ §916-b (2015).
5. Can parents direct a school nurse to make adjustments to their child's insulin doses?
Not quite. In May 2017, the US Attorneys' Office concluded an investigation into New York State Education Department's policies on adjusting insulin doses. The Office found that the state violated the Americans with Disabilities Act by refusing to make reasonable modifications to its policy of not accepting parental involvement in determining dosage adjustments. As a result of the investigation, new Guidelines for Medication Management have been written, which state that nurses must accept information from parents and take that information into account when determining an insulin dose adjustment, within a physician prescribed range in the child's DMMP. The new Guidelines leave the final decision as to an adjustment up to the nurse.
- Letter of Finding regarding New York's violation of the ADA
- Letter of Resolution outlining the changes New York needed to make to comply with the law
- Revised Guidelines for Medication Management
- DMMP Addendum for Physicians to authorize parental dosing adjustments
Resources:
For more information, see the following resources:
- New York City Public Schools litigation court order, court-approved settlement agreement, and other information.
- NYC Public Schools Litigation Information
- NYCDOE Information for Students with Diabetes
- NY Senate Bill 1239 (2021-2022 Legislative Session) signed by the Governor on August 5, 2021, authorizing trained unlicensed school personnel to administer prescribed glucagon to students (injectable and nasal) with provider authorization.
- New York State Department of Education, "Clarification on Insulin Pumps," (Mar. 2012)
- New York Consolidated Law Service, Education Law Title 1, General Provisions, Article 19, Medical and Health Service, Section 916-b, Pupils with diabetes, and Section 921 Training of unlicensed school personnel to administer certain medications (2015)
- New York Code of Rules and Regulations, Title 8, Education Department, Chapter II, Regulations of the Commissioner, Subchapter G, Health and Physical Education, Part 136, Health Service, Section 136.7 (2015)
- New York State Department of Education, Office of Elementary, Middle, Secondary and Continuing Education, "School Executive's Bulletin: Blood Glucose Monitoring," (Jan. 2001)
- New York State Department of Education, Field Memo, "Training of Unlicensed Individuals in the Injection of Glucagon in Emergency Situation," (Mar. 2004)
- New York State Education Department, Handbook on Services to Pupils Attending Nonpublic Schools (Mar. 2013)
- New York State Department of Health, Diabetes For Health Professionals and Health Care Providers / Glucagon Training
- New York State Education Department, Office of Student Support Services, Guidelines For Medication Management in Schools (May 2017)
- New York State Department of Health, Children with Diabetes: A Resource Guide for Families and Schools. (June 2013)