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                                                       PRINTER'S NO. 802

THE GENERAL ASSEMBLY OF PENNSYLVANIA


SENATE BILL

No. 676 Session of 2005


        INTRODUCED BY CONTI, TOMLINSON, RAFFERTY, LOGAN, KITCHEN, COSTA,
           O'PAKE AND STACK, MAY 10, 2005

        REFERRED TO EDUCATION, MAY 10, 2005

                                     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 definitions, for health services, for dental
     7     examinations and dental hygiene services, for facilities, for
     8     examinations and for recommendations of health professionals;
     9     deleting provisions relating to examination by family
    10     physician or dentist; and further providing for care and
    11     treatment of school-age children, for precautions against
    12     spread of certain diseases, for medical examination of school
    13     personnel and for advisory health councils.

    14     The General Assembly of the Commonwealth of Pennsylvania
    15  hereby enacts as follows:
    16     Section 1.  Section 1401 of the act of March 10, 1949
    17  (P.L.30, No.14), known as the Public School Code of 1949,
    18  amended or added July 15, 1957 (P.L.937, No.404), August 9, 1963
    19  (P.L.641, No.339), and November 30, 2004 (P.L.1471, No.187), is
    20  amended to read:
    21     Section 1401.  Definitions.--As used in this article--
    22     (1)  "Children of school age" or "child of school age" means
    23  every child attending or who should attend an elementary grade

     1  or high school, either public or private, within the
     2  Commonwealth and children who are attending a kindergarten which
     3  is an integral part of a local school district.
     4     (2)  "Teachers" means professional employes, temporary
     5  professional employes and substitutes and instructors in public
     6  or private schools within the Commonwealth.
     7     (3)  "Other employes" means janitors, bus drivers, cooks and
     8  other cafeteria help and all others employed at schools.
     9     (4)  "School physician" means a physician [legally qualified]
    10  licensed to practice medicine and surgery or osteopathy or
    11  osteopathic surgery in the Commonwealth, who has [been appointed
    12  or approved by the Secretary of Health] contracted with a school
    13  district or joint school board to provide school physician
    14  services.
    15     (5)  "School dentist" means a [doctor of dental surgery or
    16  dental medicine legally qualified] dentist licensed to practice
    17  dentistry in the Commonwealth, who has [been appointed or
    18  approved by the Secretary of Health.] contracted with a school
    19  district or joint school board to provide school dentist
    20  services.
    21     (6)  ["Family physician" means either a doctor of medicine
    22  legally qualified to practice medicine and surgery in the
    23  Commonwealth, or an osteopath or osteopathic surgeon legally
    24  qualified to practice osteopathy or osteopathic surgery in the
    25  Commonwealth, who has been designated by the parent or guardian
    26  as the personal physician of the child.] "Primary care provider"
    27  means a physician licensed to practice medicine and surgery or
    28  osteopathic medicine and surgery, or other individual licensed
    29  or certified to practice in the Commonwealth who works in
    30  collaboration with and under the direction of a physician, who
    20050S0676B0802                  - 2 -     

     1  has been designated by the parent or guardian as the primary
     2  care provider of the child.
     3     (7)  "[Family] Private dentist" means a [doctor of dental
     4  surgery or dental medicine legally qualified] dentist licensed
     5  to practice dentistry in the Commonwealth, who has been
     6  designated by the parent or guardian as the [personal] primary
     7  dentist of the child.
     8     (8)  "School nurse" means a [licensed] registered nurse
     9  [properly certificated by the Superintendent of Public
    10  Instruction as a school nurse] licensed to practice professional
    11  nursing in the Commonwealth and certified by the Department of
    12  Education as a school nurse, who is employed by a school
    13  district or joint school board as a school nurse, or is employed
    14  in providing school nurse services to children of school age by
    15  a county health unit or a department or board of health of any
    16  municipality with which a school district or joint school board
    17  has contracted for school health services pursuant to the
    18  provisions of section 1411 of this act. The employment of any
    19  nurse employed by a school district or joint school board as a
    20  school nurse prior to the effective date of this act shall not
    21  be affected by a contract for school health services that may be
    22  entered into by any school district or joint school board under
    23  the provisions of this act.
    24     (9)  "Dental hygienist" means a dental hygienist licensed [by
    25  the State Dental Council and Examining Board, who is assigned to
    26  a school district or joint school board, or a dental hygienist
    27  licensed by the State Dental Council and Examining Board and
    28  certificated as a school dental hygienist by the Superintendent
    29  of Public Instruction,] to practice dental hygiene who is
    30  employed by a school district or joint school board as a dental
    20050S0676B0802                  - 3 -     

     1  hygienist. The employment of any dental hygienist employed by a
     2  school district or joint school board as a dental hygienist
     3  prior to the effective date of this act shall not be affected by
     4  a contract for school health services that may be entered into
     5  by any school district or joint school board under the
     6  provisions of this act.
     7     (10)  ["Medical technician" means a person skilled in the
     8  operation of X-ray or other diagnostic equipment having such
     9  training and experience as required by the Secretary of Health.]
    10  "Health care assistant" means a licensed or unlicensed
    11  individual who assists the school nurse, school physician,
    12  school dentist or other qualified health professional by
    13  performing assigned duties and who has no pupil assignments.
    14     (11)  ["Sanitarian" means a person having such training and
    15  experience as required by the Secretary of Health and qualified
    16  to conduct sanitary inspections of school buildings and grounds
    17  in connection with water supply, sewage and refuse disposal,
    18  food service, heating, lighting, ventilation and safety.]
    19  "Qualified health professional" means an individual who holds a
    20  license or certification issued by the Commonwealth which allows
    21  for the performance of a physical or dental examination or
    22  evaluation.
    23     (12)  "Asthma inhaler" means a prescribed device used for
    24  self-administration of short-acting, metered doses of prescribed
    25  medication to treat an acute asthma attack.
    26     Section 2.  Section 1402 of the act, added or amended July
    27  15, 1957 (P.L.937, No.404), August 9, 1963 (P.L.642, No.340) and
    28  December 7, 1965 (P.L.1041, No.390), is amended to read:
    29     Section 1402.  Health Services.--(a)  [Each] A school
    30  district or joint school board shall provide the following to
    20050S0676B0802                  - 4 -     

     1  each child of school age [shall be given by methods established
     2  by the Advisory Health Board], in accordance with guidelines
     3  issued by the Department of Health:
     4     (1) a vision [test by a school nurse, medical technician or
     5  teacher,] screening;
     6     (2) a hearing [test by a school nurse or medical technician,]
     7  screening;
     8     (3) a [measurement of height and weight by a school nurse or
     9  teacher,] growth screening;
    10     (4) [tests for tuberculosis under medical supervision,] a
    11  scoliosis screening; and
    12     (5) such other tests as the [Advisory Health Board]
    13  Department of Health may deem advisable to protect the health of
    14  the child. [Vision tests shall be given at least annually and
    15  other tests at intervals established by the Advisory Health
    16  Board.]
    17  A school district or joint school board shall make information
    18  available to the parent or guardian of each child informing the
    19  parent or guardian of the health screenings to be performed
    20  during the school year. School nurses and other qualified health
    21  professionals as deemed appropriate by the Department of Health
    22  shall be authorized to perform screenings under this section.
    23     (a.1)  Every child of school age shall be provided with
    24  school nurse services: Provided, however, That the number of
    25  pupils under the care of each school nurse shall not exceed [one
    26  thousand five hundred (1,500)] seven hundred fifty (750).
    27     (b)  [For each child of school age, a comprehensive health
    28  record shall be maintained by the school district or joint
    29  school board, which shall include the results of the tests,
    30  measurements and regularly scheduled examinations and special
    20050S0676B0802                  - 5 -     

     1  examinations herein specified.] A school district or joint
     2  school board shall maintain for each child of school age a
     3  health record which shall include the following:
     4     (1)  a record of immunization as required by Article XIII;
     5     (2)  a health history;
     6     (3)  results of all screenings and measurements;
     7     (4)  results of regularly scheduled and special examinations;
     8     (5)  documentation of special health care needs and plans of
     9  care; and
    10     (6)  other information as specified by the Department of
    11  Health.
    12     (b.1)  Health records shall be maintained on forms prescribed
    13  by or approved by the Department of Health.
    14     (c)  [Medical questionnaires, suitable for diagnostic
    15  purposes, furnished by the Secretary of Health and completed by
    16  the child or by the child's parent or guardian, at such times as
    17  the Secretary of Health may direct, shall become a part of the
    18  child's health record.] The health record shall include a family
    19  health history, completed by the child's parent or guardian. The
    20  health history shall be required upon entry into school and
    21  prior to or concurrent with all other required physical
    22  examinations. The health history shall be completed on forms
    23  provided by the Department of Health and shall become part of
    24  the student's school health record.
    25     (d)  All teachers and other employes shall report to the
    26  school nurse [or], school physician or school dentist any
    27  unusual behavior, changes in physical appearance, changes in
    28  attendance habits and changes in scholastic achievement, which
    29  may indicate impairment of a child's health. The school nurse or
    30  school physician or school dentist may, upon referral by the
    20050S0676B0802                  - 6 -     

     1  teacher or other employe or on his own initiative, advise a
     2  child's parent or guardian of the apparent need for a special
     3  medical or dental examination. If a parent or guardian fails to
     4  obtain the examination or fails to report the results to the
     5  [nurse or school physician] school nurse, school physician or
     6  school dentist, the [nurse or school physician] school nurse,
     7  school physician or school dentist shall arrange, in
     8  collaboration with the parent or guardian, a special [medical]
     9  physical or dental examination for the child.
    10     (e)  [The school physicians of each district or joint board
    11  shall make a medical examination and a comprehensive appraisal
    12  of the health of every child of school age, (1) upon original
    13  entry into school in the Commonwealth, (2) while in sixth grade,
    14  (3) while in eleventh grade, and (4) prior to the issuance of a
    15  farm or domestic service permit unless the child has been given
    16  a scheduled or special medical examination within the preceding
    17  four months. The health record of the child shall be made
    18  available to the school physician at the time of the regularly
    19  scheduled health appraisals.] A school district or joint school
    20  board shall ensure evidence of a physical examination of every
    21  child of school age:
    22     (1)  within one year prior to original entry into school;
    23     (2)  one year before or during the fourth grade;
    24     (3)  one year before or during the eighth grade;
    25     (4)  one year before or during the eleventh grade; and
    26     (5)  prior to the issuance of an employment certificate, or
    27  farm or domestic service permit.
    28     (e.1)  A physical examination under subsection (e) shall be
    29  performed by the child's own primary care provider and the
    30  parent or guardian shall provide the results of the physical
    20050S0676B0802                  - 7 -     

     1  examination to the school district or joint school board. If the
     2  parent or guardian does not provide the results of the physical
     3  examination prior to the deadline established by the school
     4  district or joint school board for the conduct of the
     5  examination, the school district or joint school board shall
     6  schedule the child to be examined by a qualified health
     7  professional designated by the school district or joint school
     8  board.
     9     (f)  The Secretary of Health, upon petition of the school
    10  board or joint school board or on his own initiative with the
    11  concurrence of the school board or joint school board, may
    12  [modify for individual school districts] approve a modification
    13  to the school health services program specified in this
    14  [section] this article. [The program as modified shall conform
    15  to approved medical or dental practices and shall permit valid
    16  statistical appraisals of the various components of the
    17  program.] Modifications must conform to generally accepted
    18  standards of medical, dental and nursing practices.
    19     Section 3.  Section 1403 of the act, amended August 27, 1963
    20  (P.L.1380, No.535), is amended to read:
    21     Section 1403.  Dental Examinations and Dental Hygiene
    22  Services.--(a)  [All children of school age in the Commonwealth,
    23  (i) upon original entry into the school, (ii) while in the third
    24  grade, and (iii) while in the seventh grade, shall be given a
    25  dental examination by a school dentist: Provided, however, That
    26  this requirement shall not apply to those school districts or
    27  joint school boards which have instituted a program of dental
    28  hygiene services as provided in subsection (b) of this section.]
    29  A school district or joint school board shall ensure evidence of
    30  a dental examination of every child of school age:
    20050S0676B0802                  - 8 -     

     1     (1)  within one year prior to original entry into school;
     2     (2)  one year before or during the third grade; and
     3     (3)  one year before or during the seventh grade.
     4     (a.1)  A dental examination under subsection (a) shall be
     5  performed by the child's own private dentist and the parent or
     6  guardian shall provide the results of the dental examination to
     7  the school district or joint school board. If the parent or
     8  guardian does not provide the results of the dental examination
     9  prior to the deadline established by the school district or
    10  joint school board for the conduct of the examination, the
    11  school district or joint school board shall schedule the child
    12  to be examined by a school dentist. The school district or joint
    13  school board shall inform the parent or guardian of the date and
    14  time of the scheduled dental examination and shall obtain the
    15  prior written consent of the parent or guardian.
    16     (b)  Any school district or joint school board may institute
    17  a program of dental hygiene services for children of school age,
    18  which program shall be approved by the [Secretary] Department of
    19  Health, and for that purpose may employ dental hygienists.
    20     Section 4.  Sections 1404 and 1405 of the act, added July 15,
    21  1957 (P.L.937, No.404), are amended to read:
    22     Section 1404.  [Place of Examination; Use of Hospital
    23  Facilities.--The school physician and school dentist shall
    24  conduct medical, dental and other examinations in rooms set
    25  aside for this special purpose and equipped with adequate
    26  facilities and with such other accessories as may be required by
    27  the Secretary of Health for the thorough examination of
    28  children. The school physicians shall require the removal of
    29  sufficient clothing to insure complete examination. If
    30  facilities in schools are inadequate for conducting medical,
    20050S0676B0802                  - 9 -     

     1  dental and other examinations, the school districts or joint
     2  school boards and private schools may, subject to the approval
     3  of the Secretary of Health, make arrangements for the use of
     4  laboratories and facilities of hospitals or clinics for
     5  examinations herein provided for.] Facilities for Delivery of
     6  Health Services.--Health services delivered to children of
     7  school age by school health program staff shall be provided in
     8  rooms or facilities set aside for this purpose and equipped to
     9  meet minimum standards as required by the Department of Health.
    10  A school district or joint school board may, subject to the
    11  approval of the Department of Health, make arrangements for the
    12  use of alternate facilities for the provision of health
    13  services.
    14     Section 1405.  [Assistance; Presence of Parents.--Every
    15  school physician shall be assisted by a school nurse and every
    16  school dentist by a dental hygienist, if available, or trained
    17  assistant, who shall be present during each examination. Parents
    18  or guardians of children of school age shall be advised in
    19  advance of the date of examination and urged to be present.
    20  Medical examinations shall be made in the presence of the parent
    21  or guardian of the child when so requested by the parent or
    22  guardian.] Physical Examinations and Oral Health Examinations or
    23  Screenings by Qualified Health Professionals.--(a)  A qualified
    24  health professional designated by a school district or joint
    25  school board shall perform an examination only when the parent
    26  or guardian of a child of school age fails to obtain a private
    27  examination within the time frames specified by the school
    28  district or joint school board. A school nurse, dental hygienist
    29  or health care assistant shall assist the qualified health
    30  professional during the examination. A school with a dental
    20050S0676B0802                 - 10 -     

     1  hygiene services program may permit a school nurse or health
     2  care assistant to assist during a dental screening.
     3     (b)  A school district or joint school board shall advise the
     4  parent or guardian of a child in advance of the date, time and
     5  place of an examination or screening and invite the parent or
     6  guardian to be present. An examination or screening shall be
     7  made in the presence of the parent or guardian of a child when
     8  the parent or guardian requests to be present. A school district
     9  or joint school board shall obtain the prior written consent of
    10  the parent or guardian before a qualified health professional
    11  conducts an examination or screening.
    12     (c)  A qualified health professional performing an
    13  examination or screening shall have access to a child's health
    14  record maintained by the school. The results of the examination
    15  or screening shall be recorded on forms prescribed or approved
    16  by the Department of Health and included in a child's health
    17  record.
    18     Section 5.  Section 1406 of the act, amended December 9, 2002
    19  (P.L.1317, No.153), is amended to read:
    20     Section 1406.  [Recommendations.--(a)  Recommendations as to
    21  medical, surgical or dental care shall be sent to each parent or
    22  guardian and to the family physician or family dentist on forms
    23  prepared or approved by the Secretary of Health with
    24  instructions to the parent or guardian to consult the family
    25  physician or family dentist and to notify the school authorities
    26  of the action taken with respect to the recommendations.
    27     (b)  School physicians or school nurses shall inform teachers
    28  of the health conditions of pupils which may affect behavior,
    29  appearance or scholastic performance.] Referral for Evaluation
    30  and Treatment.--(a)  A school district or joint school board
    20050S0676B0802                 - 11 -     

     1  shall send the recommendation of a qualified health professional
     2  for further evaluation or treatment of a child to the child's
     3  parent or guardian with instructions to the parent or guardian
     4  to consult the child's primary care provider, private dentist or
     5  other appropriate health care provider and to notify the school
     6  nurse of the action taken with respect to the recommendation.
     7     (c)  Notice of the existence of and eligibility for the
     8  program under Article XXIII of the act of May 17, 1921 (P.L.682,
     9  No.284), known as "The Insurance Company Law of 1921," shall be
    10  prepared by, paid for and provided to each school district in
    11  Pennsylvania by the Insurance Department annually, not later
    12  than the fifteenth day of August, in sufficient quantities to
    13  provide the parent or legal guardian of every school student
    14  enrolled in the district with such notice. The school district
    15  shall provide such notice to the parent or guardian of each
    16  student enrolled in the district during the school year. The
    17  Insurance Department shall provide sufficient copies of the
    18  notice to nonpublic schools upon request.
    19     Section 6.  Section 1407 of the act is repealed.
    20     Section 7.  Sections 1414 and 1416 of the act, added July 15,
    21  1957 (P.L.937, No.404), are amended to read:
    22     Section 1414.  [Care and Treatment of Pupils] Ancillary
    23  Health Services.--Any school district or joint school board may
    24  provide for the health care and treatment of [defective eyes,
    25  ears and teeth of] all children of school age within the
    26  district if the school district or joint school board has
    27  obtained prior written consent of the child's parent or
    28  guardian.
    29     Section 1416.  [Precautions Against Spread of Tuberculosis.--
    30  No person having any form of tuberculosis in a transmissible
    20050S0676B0802                 - 12 -     

     1  stage shall be a pupil, teacher, janitor or any other employe in
     2  any school except in a special school carried on under the
     3  regulations made for such schools by the Secretary of Health.
     4  The board of directors of any school district or joint school
     5  board may appropriate the necessary funds to pay for X-ray or
     6  other medical examinations to determine the presence or absence
     7  of tuberculosis in any teacher, janitor or other employe of the
     8  district.] Precautions Against the Spread of Communicable
     9  Disease.--A student or any person having direct contact with
    10  students having or suspected of having a communicable disease,
    11  infection or condition listed in 28 Pa. Code § 27.71 (relating
    12  to exclusion of children, and staff having contact with children
    13  for specified diseases and infectious conditions), 27.72
    14  (relating to exclusions of children, and staff having contact
    15  with children, for showing symptoms) and 27.75 (relating to
    16  exclusion of children, and staff having contact with children,
    17  during a measles outbreak) shall be excluded from school in
    18  accordance with the applicable regulation. Readmission to school
    19  shall be governed by 28 Pa. Code § 27.71, 27.73 (relating to
    20  readmission of excluded children, and staff having contact with
    21  children) or 27.74 (relating to readmission of exposed or
    22  isolated children, and staff having contact with children), as
    23  applicable. A school district or joint school board may
    24  appropriate the necessary funds to pay for examinations and
    25  testing to determine the presence or absence of a communicable
    26  disease.
    27     Section 8.  Section 1418 of the act, amended July 14, 1971
    28  (P.L.229, No.47), is amended to read:
    29     Section 1418.  [Medical Examinations of Teachers and Other
    30  Persons.--(a)  All teachers, janitors, cooks and other cafeteria
    20050S0676B0802                 - 13 -     

     1  help and all others employed at schools shall be required to
     2  take a pre-employment medical examination, the results of which
     3  shall be recorded on forms prescribed by the Secretary of Health
     4  and shall be made available to the employing authorities.
     5     (b)  Each teacher, any other school employe and any person
     6  providing services for school children under contract shall be
     7  given tests for tuberculosis in accordance with rules and
     8  regulations adopted by the Advisory Health Board. Each student
     9  teacher and volunteer participating in student activities shall
    10  be given the same tests for tuberculosis, but no person shall be
    11  required to submit to a particular test if he shall furnish a
    12  statement setting forth adequate reasons for being excused from
    13  taking the test. In such case, an alternative method of testing
    14  shall be administered.
    15     (c)  School boards may require a special medical examination
    16  for any school employe at any time.] Health Evaluations of
    17  School Personnel.--(a)  A school district or joint school board
    18  shall insure that each teacher and other employe, prior to
    19  beginning work, provides documentation on a form prescribed or
    20  approved by the Department of Health evidencing a physical
    21  examination performed by a qualified health professional within
    22  one (1) year prior to the person's start date. The results of
    23  the physical examination shall include information showing that
    24  the individual was evaluated for tuberculosis risk factors and
    25  for other communicable diseases listed in 28 Pa. Code § 27.71
    26  (relating to exclusion of children, and staff having contact
    27  with children, for specified diseases and infectious conditions)
    28  and tested as necessary.
    29     (b)  A school district or joint school board shall insure
    30  that each individual, including a volunteer, who will have
    20050S0676B0802                 - 14 -     

     1  direct contact with students for ten (10) or more hours weekly,
     2  be evaluated prior to contact with students for tuberculosis
     3  risk factors and other communicable diseases and tested as
     4  necessary. Documentation shall be provided on a form prescribed
     5  or approved by the Department of Health.
     6     (d)  [Medical examinations] The physical examination and
     7  evaluation for tuberculosis risk factors and other communicable
     8  diseases shall be made by the school physician or other
     9  qualified health professional of the district if [provision
    10  therefor is made by] the district or joint school board chooses
    11  or by a [physician] qualified health professional of the
    12  [employe's] person's own choice [legally qualified to practice
    13  medicine and surgery or osteopathy or osteopathic surgery in the
    14  Commonwealth].
    15     Section 9.  Section 1422 of the act, amended January 14, 1970
    16  (1969 P.L.468, No.192), is amended to read:
    17     Section 1422.  Advisory Health Councils.--[District
    18  superintendents may set up advisory health councils to study
    19  health needs and to assist in organizing follow-up programs. An
    20  advisory health council shall be composed of representatives of
    21  the medical and dental associations, social organizations,
    22  veterans' organizations, parent-teacher associations, service
    23  clubs and other organizations in the area served. Those making
    24  the medical and dental examinations shall make to this advisory
    25  council an annual report, and later a report on the remedial
    26  work which has been accomplished during the school year.] School
    27  districts or joint school boards, individually or jointly, may
    28  establish an advisory health council to provide advice and
    29  support to assess health needs, initiate recommendations, and
    30  plan and evaluate programs and services that will contribute
    20050S0676B0802                 - 15 -     

     1  toward the health, safety and well-being of the school
     2  community. School districts which receive funding through the
     3  National School Lunch Act (60 Stat. 230, 42 U.S.C. § 1751 et
     4  seq.) or the Child Nutrition Act of 1966 (Public Law 89-642, 42
     5  U.S.C. § 1771 et seq.) may establish an advisory health council
     6  to help plan, develop and implement a health and wellness plan
     7  as required by section 204 of the Child Nutrition and WIC
     8  Reauthorization Act of 2004 (Public Law 108-265, 118 Stat. 780).
     9  Membership of the council may include representation from the
    10  following:
    11     (1)  the school district's health services program;
    12     (2)  school administration, including school board members;
    13     (3)  teachers;
    14     (4)  guidance counselors;
    15     (5)  students;
    16     (6)  parent/teacher organizations;
    17     (7)  community health providers;
    18     (8)  local public health organizations; and
    19     (9)  other entities as deemed necessary and appropriate by
    20  the school district.
    21     Section 10.  This act shall take effect in 120 days.






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