THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY M. SMITH, BELFANTI, BEYER, BRENNAN, BRIGGS, CALTAGIRONE, DONATUCCI, FABRIZIO, FREEMAN, GEORGE, GRUCELA, HARHAI, HARPER, HENNESSEY, KORTZ, MANN, McGEEHAN, McILVAINE SMITH, MICOZZIE, MILLARD, MOUL, M. O'BRIEN, PALLONE, READSHAW, SAINATO, SEIP, SIPTROTH, K. SMITH AND YOUNGBLOOD, MARCH 25, 2009

REFERRED TO COMMITTEE ON EDUCATION, MARCH 25, 2009  

AN ACT

Amending the act of March 10, 1949 (P.L.30, No.14), entitled "An

act relating to the public school system, including certain

provisions applicable as well to private and parochial

schools; amending, revising, consolidating and changing the

laws relating thereto," in school health services, providing

for training of school employees in diabetes care and

treatment, for diabetes medical management plans, for

independent monitoring and treatment and for certain immunity

from civil liability.

The General Assembly finds and declares as follows:

(1)  Diabetes is a serious, chronic disease that impairs

the body's ability to use food. Diabetes must be managed 24

hours a day in order to avoid the potentially life-

threatening, short-term consequences of blood sugar levels

that are either too high or too low, and to avoid or delay

the serious long-term complications of high blood sugar

levels which include blindness, amputation, heart disease and

kidney failure. In order to manage their disease, students

with diabetes must have access to the means to balance food,

medications and physical activity level while at school and

at school-related activities.

(2)  The school nurse is the most appropriate person in

the school setting to provide care for a student with

diabetes. Many schools in Pennsylvania, however, do not have

a full-time nurse. Moreover, even when a nurse is assigned to

a school full time, he or she will not always be available

during the school day, during extracurricular activities or

on field trips. Because diabetes management is needed at all

times, additional school personnel need to be prepared to

provide diabetes care at school and all school-related

activities in order for students with diabetes to be

medically safe and to have the same access to educational

opportunities as do all students in Pennsylvania.

(3)  There is a significant number of students with

diabetes, the effects of which may impact a student's ability

to learn and cause serious long-term and short-term medical

complications.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  The act of March 10, 1949 (P.L.30, No.14), known

as the Public School Code of 1949, is amended by adding sections

to read:

Section 1414.2.  Training of School Employes in Diabetes Care

and Treatment.--(a)  Within ninety days (90) of the effective

date of this act, the Department of Education, in cooperation

from at least the Department of Health, the American Diabetes

Association and the American Association of Diabetes Educators,

shall develop and make available to schools guidelines for the

training of school employes in diabetes care and treatment. At

the minimum, the training guidelines shall include instruction

in:

(1)  recognition and treatment of hypoglycemia and

hyperglycemia;

(2)  understanding the appropriate actions to take when blood

glucose levels are outside of target ranges;

(3)  understanding physician instructions concerning diabetes

medication drug dosage, frequency and the manner of

administration;

(4)  performance of finger-stick blood glucose checking,

ketone checking and recording the results;

(5)  the administration of glucagon and insulin and the

recording of results;

(6)  recommended schedules and food intake for meals and

snacks, the effect of physical activity upon blood glucose

levels and actions to be implemented in the case of schedule

disruption;

(7)  understanding how to perform basic insulin pump

functions; and

(8)  recognizing complications that require emergency

assistance.

(b)  The governing board of each school entity shall direct

the school nurse or school physician to select at least three

(3) school employes from each school in which a diabetic student

is enrolled to receive the training as described in subsection

(a) and determine by whom the training is to be provided. School

employes may not be subject to any penalty or disciplinary

action for refusing to serve as trained diabetes personnel.

Training required under this section may be provided by a school

nurse, school physician or other health care professional with

expertise in diabetes.

(c)  Training shall take place prior to the commencement of

each school year or as needed when a diabetic student is newly

enrolled or a student is newly diagnosed with diabetes. Training

shall be coordinated by a school nurse.

(d)  For the purposes of this section, "school" means any

elementary or secondary public charter or nonpublic school,

intermediate unit or area vocational-technical school. "School

entity" means any school district, intermediate unit, area

vocational-technical school, charter school or nonpublic school

located in this Commonwealth.

Section 1414.3.  Diabetes Medical Management Plan.--(a)  At

the beginning of each school year, upon enrollment or diagnosis,

a diabetic student who seeks diabetes care in school shall

submit to the school nurse or school physician a diabetes

medical management plan, which outlines the health services

needed by the student while at school. All diabetes care

provided to a student shall be consistent with the diabetes

medical management plan of the student. The diabetes medical

management plan shall be developed by the student's parent or

guardian along with the student's physician, certified

registered nurse practitioner or physician assistant and may

include written authorization allowing:

(1)  trained diabetes personnel to perform diabetes care and

treatment upon the child if the parent or guardian so requests,

including, but not limited to, responding to blood glucose

levels that are outside of the student's target range;

administering glucagon; administering insulin or assisting a

student in administering insulin through the insulin delivery

system the student uses; providing oral diabetes medications,

checking and recording blood glucose levels and ketone levels or

assisting a student with such checking and recording; and

following instructions regarding meals, snacks and physical

activity; and

(2)  the child to conduct independent monitoring and

treatment in school, if the parent or guardian so requests. If

this request is made, the physician, certified registered nurse

practitioner or physician assistant shall provide a written

statement in the plan indicating the student has successfully

demonstrated capability of independent monitoring and

responsible behavior in self-administering treatment or

prescribed medication.

(b)  Notwithstanding any authorization granted pursuant to

subsection (a)(1), a school nurse shall be the primary provider

of diabetes care and treatment and responsible for any

delegation of care.

(c)  Any diabetic student unable to or prevented from

submitting a diabetes medical management plan to his or her

school nurse or school physician shall not be precluded from

receiving school nurse services, including the care and

treatment of diabetes.

(d)  For purposes of this section, "trained diabetes

personnel" means a school employe, other than a school nurse or

school physician, or a nonhealth care professional trained in

accordance with section 1414.2. Functions performed by these

professionals shall not constitute the practice of nursing and

shall be exempted from all applicable statutory and/or

regulatory provisions that restrict what functions can be

performed by a person who is not a licensed health care

professional or that can be delegated by a licensed health care

professional.

Section 1414.4.  Independent Monitoring and Treatment.--(a)

The governing board of each school entity shall develop a

written policy allowing diabetic students to possess on their

person at all times all necessary supplies, equipment and

prescribed medication to perform self-monitoring and treatment.

(b)  The student with diabetes shall be permitted to perform

blood glucose checks, treat hypoglycemia and hyperglycemia and

otherwise attend to the care and management of his or her

diabetes in the classroom in any area of the school or school

grounds and at any school-related activity if requested by the

parent or guardian.

(c)  The policy may revoke or restrict a student's

independent monitoring and treatment privileges if school

policies are abused or ignored.

Section 1414.5.  Required Care.--(a)  At least one trained

diabetes personnel shall be on site and available to provide

treatment and care to diabetic students during regular school

hours and at all school-sponsored activities, including, but not

limited to, extracurricular activities and field trips, where a

student with diabetes is a direct participant. No student shall

be required to attend another school solely because she or he

has diabetes.

(b)  The governing board of each school entity shall develop

a written policy that requires the distribution of information

to school bus drivers that identifies diabetic students, the

potential emergencies that may occur as a result of the

student's diabetes and the appropriate responses to such

emergencies and emergency contact information for students with

diabetes.

Section 1414.6.  Immunity from Civil Liability.--No

physician, nurse, school employe, trained diabetes personnel or

school entity shall be liable for civil damages as a result of

the activities authorized by this legislation when such acts are

performed as an ordinary reasonably prudent person would have

acted under the same or similar circumstances.

Section 2.  This act shall take effect as follows:

(1)  The addition of section 1414.5 of the act shall take

effect in 150 days.

(2)  The remainder of this act shall take effect

immediately.