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                                                       PRINTER'S NO. 552



No. 509 Session of 2007

           AND STOUT, MARCH 19, 2007


                                     AN ACT

     1  Amending the act of March 10, 1949 (P.L.30, No.14), entitled "An
     2     act relating to the public school system, including certain
     3     provisions applicable as well to private and parochial
     4     schools; amending, revising, consolidating and changing the
     5     laws relating thereto," further providing for school health
     6     services.

     7     The General Assembly finds and declares as follows:
     8         (1)  Diabetes is a serious, chronic disease that impairs
     9     the body's ability to use food. Diabetes must be managed 24
    10     hours a day in order to avoid the potentially life-
    11     threatening, short-term consequences of blood sugar levels
    12     that are either too high or too low, and to avoid or delay
    13     the serious long-term complications of high blood sugar
    14     levels which include blindness, amputation, heart disease and
    15     kidney failure. In order to manage their disease, students
    16     with diabetes must have access to the means to balance food,
    17     medications and physical activity level while at school and
    18     at school-related activities.
    19         (2)  The school nurse is the most appropriate person in

     1     the school setting to provide care for a student with
     2     diabetes. Many schools in Pennsylvania, however, do not have
     3     a full-time nurse. Moreover, even when a nurse is assigned to
     4     a school full time, he or she will not always be available
     5     during the school day, during extracurricular activities or
     6     on field trips. Because diabetes management is needed at all
     7     times, additional school personnel need to be prepared to
     8     provide diabetes care at school and all school-related
     9     activities in order for students with diabetes to be
    10     medically safe and to have the same access to educational
    11     opportunities as do all students in Pennsylvania.
    12         (3)  There is a significant number of students with
    13     diabetes, the effects of which may impact a student's ability
    14     to learn and cause serious long-term and short-term medical
    15     complications.
    16     The General Assembly of the Commonwealth of Pennsylvania
    17  hereby enacts as follows:
    18     Section 1.  The act of March 10, 1949 (P.L.30, No.14), known
    19  as the Public School Code of 1949, is amended by adding sections
    20  to read:
    21     Section 1414.2.  Training of School Employes in Diabetes Care
    22  and Treatment.--(a)  Within ninety days (90) of the effective
    23  date of this act, the Department of Education, in cooperation
    24  from at least the Department of Health, the American Diabetes
    25  Association and the American Association of Diabetes Educators,
    26  shall develop and make available to schools guidelines for the
    27  training of school employes in diabetes care and treatment. At
    28  the minimum, the training guidelines shall include instruction
    29  in:
    30     (1)  recognition and treatment of hypoglycemia and
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     1  hyperglycemia;
     2     (2)  understanding the appropriate actions to take when blood
     3  glucose levels are outside of target ranges;
     4     (3)  understanding physician instructions concerning diabetes
     5  medication drug dosage, frequency and the manner of
     6  administration;
     7     (4)  performance of finger-stick blood glucose checking,
     8  ketone checking and recording the results;
     9     (5)  the administration of glucagon and insulin and the
    10  recording of results; and
    11     (6)  recommended schedules and food intake for meals and
    12  snacks, the effect of physical activity upon blood glucose
    13  levels and actions to be implemented in the case of schedule
    14  disruption.
    15     (b)  The governing board of each school entity shall direct
    16  the school nurse or school physician to select at least three
    17  (3) school employes from each school in which a diabetic student
    18  is enrolled to receive the training as described in subsection
    19  (a) and determine by whom the training is to be provided. School
    20  employes may not be subject to any penalty or disciplinary
    21  action for refusing to serve as trained diabetes personnel.
    22  Training required under this section may be provided by a local
    23  health agency, subcontractor, school nurse, school physician or
    24  any other person skilled in providing diabetes care and
    25  treatment training required under this section.
    26     (c)  Training shall take place prior to the commencement of
    27  each school year or as needed when a diabetic student is newly
    28  enrolled or a student is newly diagnosed with diabetes.
    29     (d)  For the purposes of this section, "school" means any
    30  elementary or secondary public charter or nonpublic school,
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     1  intermediate unit or area vocational-technical school. "School
     2  entity" means any school district, intermediate unit, area
     3  vocational-technical school, charter school or nonpublic school
     4  located in this Commonwealth.
     5     Section 1414.3.  Diabetes Medical Management Plan.--(a)  At
     6  the beginning of each school year, upon enrollment or diagnosis,
     7  a diabetic student who seeks diabetes care in school shall
     8  submit to the school nurse or school physician a diabetes
     9  medical management plan, which outlines the health services
    10  needed by the student while at school. This plan shall be
    11  developed by the student's parent or guardian along with the
    12  student's physician, certified registered nurse practitioner or
    13  physician assistant and include, at the minimum, written
    14  authorization allowing:
    15     (1)  trained diabetes personnel to perform diabetes care and
    16  treatment upon the child, including, but not limited to,
    17  responding to blood glucose levels that are outside of the
    18  student's target range; administering glucagon; administering
    19  insulin or assisting a student in administering insulin through
    20  the insulin delivery system the student uses; providing oral
    21  diabetes medications, checking and recording blood glucose
    22  levels and ketone levels or assisting a student with such
    23  checking and recording; and following instructions regarding
    24  meals, snacks and physical activity; and
    25     (2)  the child to conduct independent monitoring and
    26  treatment in school, if the parent or guardian so requests. If
    27  this request is made, the physician, certified registered nurse
    28  practitioner or physician assistant shall provide a written
    29  statement in the plan indicating the student has successfully
    30  demonstrated capability of independent monitoring and
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     1  responsible behavior in self-administering treatment or
     2  prescribed medication.
     3     (b)  Notwithstanding any authorization granted pursuant to
     4  subsection (a)(1), a school nurse shall be the primary provider
     5  of diabetes care and treatment and responsible for any
     6  delegation of care.
     7     (c)  Any diabetic student unable to or prevented from
     8  submitting a diabetes medical management plan to his or her
     9  school nurse or school physician shall not be precluded from
    10  receiving school nurse services, including the care and
    11  treatment of diabetes.
    12     (d)  For purposes of this section, "trained diabetes
    13  personnel" means a school employe, other than a school nurse or
    14  school physician, or a nonhealth care professional trained in
    15  accordance with section 1414.2. Functions performed by these
    16  professionals shall not constitute the practice of nursing and
    17  shall be exempted from all applicable statutory and/or
    18  regulatory provisions that restrict what functions can be
    19  performed by a person who is not a licensed health care
    20  professional.
    21     Section 1414.4.  Independent Monitoring and Treatment.--The
    22  governing board of each school entity shall develop a written
    23  policy allowing diabetic students to possess on their person at
    24  all times all necessary supplies, equipment and prescribed
    25  medication to perform self-monitoring and treatment. The policy
    26  may revoke or restrict a student's independent monitoring and
    27  treatment privileges if school policies are abused or ignored.
    28     Section 1414.5.  Required Care.--(a)  At least one trained
    29  diabetes personnel shall be on site and available to provide
    30  treatment and care to diabetic students during regular school
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     1  hours and at all school-sponsored activities, including, but not
     2  limited to, extracurricular activities and field trips, where a
     3  student with diabetes is a direct participant. No student shall
     4  be required to attend another school solely because she or he
     5  has diabetes.
     6     (b)  The governing board of each school entity shall develop
     7  a written policy that requires the distribution of information
     8  to school bus drivers that identifies diabetic students, the
     9  potential emergencies that may occur as a result of the
    10  student's diabetes and the appropriate responses to such
    11  emergencies and emergency contact information for students with
    12  diabetes.
    13     Section 1414.6.  Immunity from Civil Liability.--No
    14  physician, nurse, school employe, trained diabetes personnel or
    15  school entity shall be liable for civil damages as a result of
    16  the activities authorized by this legislation when such acts are
    17  performed as an ordinary reasonably prudent person would have
    18  acted under the same or similar circumstances.
    19     Section 2.  This act shall take effect as follows:
    20         (1)  The addition of section 1414.5 of the act shall take
    21     effect in 150 days.
    22         (2)  The remainder of this act shall take effect
    23     immediately.

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