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                                                      PRINTER'S NO. 2071

THE GENERAL ASSEMBLY OF PENNSYLVANIA


SENATE BILL

No. 1332 Session of 2006


        INTRODUCED BY CONTI, SEPTEMBER 22, 2006

        REFERRED TO EDUCATION, SEPTEMBER 22, 2006

                                     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 and for medical examination of
    13     school personnel.

    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
    20060S1332B2071                  - 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,] to practice
    26  dental hygiene in this Commonwealth who is assigned to a school
    27  district or joint school board, or a dental hygienist licensed
    28  [by the State Dental Council and Examining Board and
    29  certificated as a school dental hygienist by the Superintendent
    30  of Public Instruction,] to practice dental hygiene in this
    20060S1332B2071                  - 3 -     

     1  Commonwealth and certificated by the Department of Education as
     2  a school dental hygienist who is employed by a school district
     3  or joint school board as a dental hygienist. The employment of
     4  any dental hygienist employed by a school district or joint
     5  school board as a dental hygienist prior to the effective date
     6  of this act shall not be affected by a contract for school
     7  health services that may be entered into by any school district
     8  or joint school board under the provisions of this act.
     9     (10)  ["Medical technician" means a person skilled in the
    10  operation of X-ray or other diagnostic equipment having such
    11  training and experience as required by the Secretary of Health.]
    12  "Health care assistant" means a licensed or unlicensed
    13  individual who assists the school nurse, school physician,
    14  school dentist or other qualified health professional by
    15  performing assigned duties and who has no pupil assignments.
    16     (11)  ["Sanitarian" means a person having such training and
    17  experience as required by the Secretary of Health and qualified
    18  to conduct sanitary inspections of school buildings and grounds
    19  in connection with water supply, sewage and refuse disposal,
    20  food service, heating, lighting, ventilation and safety.]
    21  "Qualified health professional" means an individual who holds a
    22  license or certification issued by the Commonwealth which allows
    23  for the performance of a physical or dental examination or
    24  evaluation.
    25     (12)  "Asthma inhaler" means a prescribed device used for
    26  self-administration of short-acting, metered doses of prescribed
    27  medication to treat an acute asthma attack.
    28     Section 2.  Section 1402 of the act, amended or added July
    29  15, 1957 (P.L.937, No.404), December 7, 1965 (P.L.1041, No.390)
    30  and July 11, 2006 (P.L.1092, No.114), is amended to read:
    20060S1332B2071                  - 4 -     

     1     Section 1402.  Health Services.--(a)  [Each] A school
     2  district or joint school board shall provide the following to
     3  each child of school age [shall be given by methods established
     4  by the Advisory Health Board], in accordance with guidelines
     5  issued by the Department of Health:
     6     (1) a vision [test by a school nurse, medical technician or
     7  teacher,] screening;
     8     (2) a hearing [test by a school nurse or medical technician,]
     9  screening;
    10     (3) a [measurement of height and weight by a school nurse or
    11  teacher, who shall use the measurement to compute a child's
    12  weight-for-height ratio,] growth screening, which shall include
    13  computation of a child's weight-for-height ratio;
    14     (4) [tests for tuberculosis under medical supervision,] a
    15  scoliosis screening; and
    16     (5) such other tests as the [Advisory Health Board]
    17  Department of Health may deem advisable to protect the health of
    18  the child. [Vision tests shall be given at least annually and
    19  other tests at intervals established by the Advisory Health
    20  Board.]
    21  A school district or joint school board shall make information
    22  available to the parent or guardian of each child informing the
    23  parent or guardian of the health screenings to be performed
    24  during the school year. School nurses and other qualified school
    25  personnel as determined by the rules and regulations of the
    26  Department of Health shall be authorized to perform screenings
    27  under this section.
    28     (a.1)  Every child of school age shall be provided with
    29  school nurse services: Provided, however, That the number of
    30  pupils under the care of each school nurse shall not exceed one
    20060S1332B2071                  - 5 -     

     1  thousand five hundred (1,500).
     2     (b)  [For each child of school age, a comprehensive health
     3  record shall be maintained by the school district or joint
     4  school board, which shall include the results of the tests,
     5  measurements and regularly scheduled examinations and special
     6  examinations herein specified.] A school district or joint
     7  school board shall maintain for each child of school age a
     8  health record which shall include the following:
     9     (1)  a record of immunization as required by Article XIII;
    10     (2)  results of all screenings and measurements;
    11     (3)  results of regularly scheduled and special examinations;
    12     (4)  documentation of special health care needs and plans of
    13  care; and
    14     (5)  other information as specified by the Department of
    15  Health.
    16     (b.1)  Health records shall be maintained on forms prescribed
    17  by or approved by the Department of Health.
    18     (c)  Medical questionnaires, suitable for diagnostic
    19  purposes, furnished by the Secretary of Health and completed by
    20  the child or by the child's parent or guardian, at such times as
    21  the Secretary of Health may direct, shall become a part of the
    22  child's health record.
    23     (d)  All teachers and other employes shall report to the
    24  school nurse [or], school physician or school dentist any
    25  unusual behavior, changes in physical appearance, changes in
    26  attendance habits and changes in scholastic achievement, which
    27  may indicate impairment of a child's health. The school nurse or
    28  school physician or school dentist may, upon referral by the
    29  teacher or other employe or on his own initiative, advise a
    30  child's parent or guardian of the apparent need for a special
    20060S1332B2071                  - 6 -     

     1  medical or dental examination. If a parent or guardian fails to
     2  obtain the examination or fails to report the results to the
     3  [nurse or school physician] school nurse, school physician or
     4  school dentist, the [nurse or school physician] school nurse,
     5  school physician or school dentist shall arrange, in
     6  collaboration with the parent or guardian, a special [medical]
     7  physical or dental examination for the child.
     8     (e)  [The school physicians of each district or joint board
     9  shall make a medical examination and a comprehensive appraisal
    10  of the health of every child of school age, (1) upon original
    11  entry into school in the Commonwealth, (2) while in sixth grade,
    12  (3) while in eleventh grade, and (4) prior to the issuance of a
    13  farm or domestic service permit unless the child has been given
    14  a scheduled or special medical examination within the preceding
    15  four months. The health record of the child shall be made
    16  available to the school physician at the time of the regularly
    17  scheduled health appraisals.] A school district or joint school
    18  board shall ensure evidence of a physical examination of every
    19  child of school age:
    20     (1)  within one year prior to original entry into school;
    21     (2)  one year before or during the fourth grade;
    22     (3)  one year before or during the eighth grade;
    23     (4)  one year before or during the eleventh grade; and
    24     (5)  prior to the issuance of an employment certificate, or
    25  farm or domestic service permit.
    26     (e.1)  A physical examination under subsection (e) shall be
    27  performed by the child's own primary care provider and the
    28  parent or guardian shall provide the results of the physical
    29  examination to the school district or joint school board. If the
    30  parent or guardian does not provide the results of the physical
    20060S1332B2071                  - 7 -     

     1  examination prior to the deadline established by the school
     2  district or joint school board for the conduct of the
     3  examination, the school district or joint school board shall
     4  schedule the child to be examined by a qualified health
     5  professional designated by the school district or joint school
     6  board.
     7     (f)  The Secretary of Health, upon petition of the school
     8  board or joint school board or on his own initiative with the
     9  concurrence of the school board or joint school board, may
    10  [modify for individual school districts] approve a modification
    11  to the school health services program specified in this
    12  [section] this article. [The program as modified shall conform
    13  to approved medical or dental practices and shall permit valid
    14  statistical appraisals of the various components of the
    15  program.] Modifications must conform to generally accepted
    16  standards of medical, dental and nursing practices.
    17     Section 3.  Section 1403 of the act, amended August 27, 1963
    18  (P.L.1380, No.535), is amended to read:
    19     Section 1403.  Dental Examinations and Dental Hygiene
    20  Services.--(a)  [All children of school age in the Commonwealth,
    21  (i) upon original entry into the school, (ii) while in the third
    22  grade, and (iii) while in the seventh grade, shall be given a
    23  dental examination by a school dentist: Provided, however, That
    24  this requirement shall not apply to those school districts or
    25  joint school boards which have instituted a program of dental
    26  hygiene services as provided in subsection (b) of this section.]
    27  A school district or joint school board shall ensure evidence of
    28  a dental examination of every child of school age:
    29     (1)  within one year prior to original entry into school;
    30     (2)  one year before or during the third grade; and
    20060S1332B2071                  - 8 -     

     1     (3)  one year before or during the seventh grade.
     2     (a.1)  A dental examination under subsection (a) shall be
     3  performed by the child's own private dentist and the parent or
     4  guardian shall provide the results of the dental examination to
     5  the school district or joint school board. If the parent or
     6  guardian does not provide the results of the dental examination
     7  prior to the deadline established by the school district or
     8  joint school board for the conduct of the examination, the
     9  school district or joint school board shall schedule the child
    10  to be examined by a school dentist.
    11     (b)  Any school district or joint school board may institute
    12  a program of dental hygiene services for children of school age,
    13  which program shall be approved by the [Secretary] Department of
    14  Health, and for that purpose may employ dental hygienists.
    15     Section 4.  Sections 1404 and 1405 of the act, added July 15,
    16  1957 (P.L.937, No.404), are amended to read:
    17     Section 1404.  [Place of Examination; Use of Hospital
    18  Facilities.--The school physician and school dentist shall
    19  conduct medical, dental and other examinations in rooms set
    20  aside for this special purpose and equipped with adequate
    21  facilities and with such other accessories as may be required by
    22  the Secretary of Health for the thorough examination of
    23  children. The school physicians shall require the removal of
    24  sufficient clothing to insure complete examination. If
    25  facilities in schools are inadequate for conducting medical,
    26  dental and other examinations, the school districts or joint
    27  school boards and private schools may, subject to the approval
    28  of the Secretary of Health, make arrangements for the use of
    29  laboratories and facilities of hospitals or clinics for
    30  examinations herein provided for.] Facilities for Delivery of
    20060S1332B2071                  - 9 -     

     1  Health Services.--Health services delivered to children of
     2  school age by school health program staff shall be provided in
     3  rooms or facilities set aside for this purpose and equipped to
     4  meet minimum standards as required by the Department of Health.
     5  A school district or joint school board may, subject to the
     6  approval of the Department of Health, make arrangements for the
     7  use of alternate facilities for the provision of health
     8  services.
     9     Section 1405.  [Assistance; Presence of Parents.--Every
    10  school physician shall be assisted by a school nurse and every
    11  school dentist by a dental hygienist, if available, or trained
    12  assistant, who shall be present during each examination. Parents
    13  or guardians of children of school age shall be advised in
    14  advance of the date of examination and urged to be present.
    15  Medical examinations shall be made in the presence of the parent
    16  or guardian of the child when so requested by the parent or
    17  guardian.] Physical Examinations and Dental Examinations or
    18  Dental Screenings by Qualified Health Professionals.--(a)  A
    19  qualified health professional designated by a school district or
    20  joint school board shall perform an examination only when the
    21  parent or guardian of a child of school age fails to obtain a
    22  private examination within the time frames specified by the
    23  school district or joint school board. A school nurse, dental
    24  hygienist or health care assistant shall assist the qualified
    25  health professional during the examination. A school with a
    26  dental hygiene services program may use a dental hygienist to
    27  perform a dental screening and permit a school nurse or health
    28  care assistant to assist during a dental screening.
    29     (b)  A school district or joint school board shall advise the
    30  parent or guardian of a child in advance of the date, time and
    20060S1332B2071                 - 10 -     

     1  place of a physical or dental examination or dental screening
     2  and invite the parent or guardian to be present. A physical or
     3  dental examination or dental screening shall be made in the
     4  presence of the parent or guardian of a child when the parent or
     5  guardian requests to be present. A school district or joint
     6  school board shall obtain the prior written consent of the
     7  parent or guardian before a qualified health professional
     8  conducts a physical or dental examination or dental screening.
     9     (c)  A qualified health professional performing a physical or
    10  dental examination or dental screening shall have access to a
    11  child's health record maintained by the school. The results of
    12  the physical or dental examination or dental screening shall be
    13  recorded on forms prescribed or approved by the Department of
    14  Health and included in a child's health record.
    15     Section 5.  Section 1406 of the act, amended December 9, 2002
    16  (P.L.1317, No.153), is amended to read:
    17     Section 1406.  [Recommendations.--(a)  Recommendations as to
    18  medical, surgical or dental care shall be sent to each parent or
    19  guardian and to the family physician or family dentist on forms
    20  prepared or approved by the Secretary of Health with
    21  instructions to the parent or guardian to consult the family
    22  physician or family dentist and to notify the school authorities
    23  of the action taken with respect to the recommendations.
    24     (b)  School physicians or school nurses shall inform teachers
    25  of the health conditions of pupils which may affect behavior,
    26  appearance or scholastic performance.] Referral for Evaluation
    27  and Treatment.--(a)  In the event the school district or joint
    28  school board provides the physical or dental examination, the
    29  school district or joint school board shall send the
    30  recommendation of a qualified health professional for further
    20060S1332B2071                 - 11 -     

     1  evaluation or treatment of a child to the child's parent or
     2  guardian with instructions to the parent or guardian to consult
     3  the child's primary care provider, private dentist or other
     4  appropriate health care provider and to notify the school nurse
     5  of the action taken with respect to the recommendation.
     6     (c)  Notice of the existence of and eligibility for the
     7  program under Article XXIII of the act of May 17, 1921 (P.L.682,
     8  No.284), known as "The Insurance Company Law of 1921," shall be
     9  prepared by, paid for and provided to each school district in
    10  Pennsylvania by the Insurance Department annually, not later
    11  than the fifteenth day of August, in sufficient quantities to
    12  provide the parent or legal guardian of every school student
    13  enrolled in the district with such notice. The school district
    14  shall provide such notice to the parent or guardian of each
    15  student enrolled in the district during the school year. The
    16  Insurance Department shall provide sufficient copies of the
    17  notice to nonpublic schools upon request.
    18     Section 6.  Section 1407 of the act is repealed.
    19     Section 7.  Sections 1414 and 1416 of the act, added July 15,
    20  1957 (P.L.937, No.404), are amended to read:
    21     Section 1414.  [Care and Treatment of Pupils] Ancillary
    22  Health Services.--Any school district or joint school board may
    23  provide for the health care and treatment of [defective eyes,
    24  ears and teeth of] all children of school age within the
    25  district if the school district or joint school board has
    26  obtained prior written consent of the child's parent or
    27  guardian.
    28     Section 1416.  [Precautions Against Spread of Tuberculosis.--
    29  No person having any form of tuberculosis in a transmissible
    30  stage shall be a pupil, teacher, janitor or any other employe in
    20060S1332B2071                 - 12 -     

     1  any school except in a special school carried on under the
     2  regulations made for such schools by the Secretary of Health.
     3  The board of directors of any school district or joint school
     4  board may appropriate the necessary funds to pay for X-ray or
     5  other medical examinations to determine the presence or absence
     6  of tuberculosis in any teacher, janitor or other employe of the
     7  district.] Precautions Against the Spread of Communicable
     8  Disease.--A student or any person having direct contact with
     9  students having or suspected of having a communicable disease,
    10  infection or condition listed in 28 Pa. Code § 27.71 (relating
    11  to exclusion of children, and staff having contact with children
    12  for specified diseases and infectious conditions), 27.72
    13  (relating to exclusions of children, and staff having contact
    14  with children, for showing symptoms) and 27.75 (relating to
    15  exclusion of children, and staff having contact with children,
    16  during a measles outbreak) shall be excluded from school in
    17  accordance with the applicable regulation. Readmission to school
    18  shall be governed by 28 Pa. Code § 27.71, 27.73 (relating to
    19  readmission of excluded children, and staff having contact with
    20  children) or 27.74 (relating to readmission of exposed or
    21  isolated children, and staff having contact with children), as
    22  applicable. A school district or joint school board may
    23  appropriate the necessary funds to pay for examinations and
    24  testing to determine the presence or absence of a communicable
    25  disease.
    26     Section 8.  Section 1418 of the act, amended July 14, 1971
    27  (P.L.229, No.47), is amended to read:
    28     Section 1418.  [Medical Examinations of Teachers and Other
    29  Persons.--(a)  All teachers, janitors, cooks and other cafeteria
    30  help and all others employed at schools shall be required to
    20060S1332B2071                 - 13 -     

     1  take a pre-employment medical examination, the results of which
     2  shall be recorded on forms prescribed by the Secretary of Health
     3  and shall be made available to the employing authorities.
     4     (b)  Each teacher, any other school employe and any person
     5  providing services for school children under contract shall be
     6  given tests for tuberculosis in accordance with rules and
     7  regulations adopted by the Advisory Health Board. Each student
     8  teacher and volunteer participating in student activities shall
     9  be given the same tests for tuberculosis, but no person shall be
    10  required to submit to a particular test if he shall furnish a
    11  statement setting forth adequate reasons for being excused from
    12  taking the test. In such case, an alternative method of testing
    13  shall be administered.
    14     (c)  School boards may require a special medical examination
    15  for any school employe at any time.
    16     (d)  Medical examinations shall be made by the school
    17  physician of the district if provision therefor is made by the
    18  district or joint school board or by a physician of the
    19  employe's own choice legally qualified to practice medicine and
    20  surgery or osteopathy or osteopathic surgery in the
    21  Commonwealth.] Health Evaluations of School Personnel.--(a)  A
    22  school district or joint school board shall insure that each
    23  teacher and other employe, prior to beginning work, provides
    24  documentation on a form prescribed or approved by the Department
    25  of Health evidencing a physical examination performed by a
    26  qualified health professional within one (1) year prior to the
    27  person's start date. The results of the physical examination
    28  shall include information showing that the individual was
    29  evaluated for tuberculosis risk factors and for other
    30  communicable diseases listed in 28 Pa. Code § 27.71 (relating to
    20060S1332B2071                 - 14 -     

     1  exclusion of children, and staff having contact with children,
     2  for specified diseases and infectious conditions), § 27.72
     3  (relating to exclusion of children, and staff having contact
     4  with children, for showing symptoms) and § 27.75 (relating to
     5  exclusion of children, and staff having contact with children,
     6  during a measles outbreak) and tested as necessary.
     7     (b)  A school district or joint school board shall insure
     8  that each individual, including a volunteer, who will have
     9  direct contact with students for ten (10) or more hours weekly,
    10  be evaluated prior to contact with students for tuberculosis
    11  risk factors and other communicable diseases as listed in 28 Pa.
    12  Code §§ 27.71, 27.72 and 27.75 and tested as necessary.
    13  Documentation shall be provided on a form prescribed or approved
    14  by the Department of Health.
    15     (c)  School boards may require a special medical examination
    16  for any school employe at any time.
    17     (d)  The physical examination and evaluation for tuberculosis
    18  risk factors, other communicable diseases and special medical
    19  examinations shall be made by the school physician, or other
    20  qualified health professional of the district, or by a qualified
    21  health professional of the employe's own choice.
    22     Section 9.  The Department of Education shall establish a
    23  three-year implementation schedule for phasing in the physical
    24  examination requirements for school-age children under section
    25  1402(e) of the act.
    26     Section 10.  This act shall take effect in 180 days.



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