Florida Senate - 2010                                     SB 896 
        
       By Senator Peaden 
       2-00716-10                                             2010896__ 
    1                        A bill to be entitled                       
    2         An act relating to the treatment of students who have 
    3         diabetes; providing definitions; requiring the 
    4         Department of Health to develop guidelines, with the 
    5         assistance of certain entities, for the training of 
    6         diabetes personnel; providing criteria for the 
    7         training; requiring the Department of Health to adopt 
    8         the guidelines by a specified date; requiring each 
    9         district school board and the governing body of each 
   10         private and charter school to provide training to a 
   11         minimum number of school employees; providing that a 
   12         school employee is not subject to any penalty or 
   13         disciplinary action for refusing to serve as a member 
   14         of the trained diabetes personnel; requiring a school 
   15         nurse to coordinate the training; requiring the school 
   16         nurse or another health care professional to provide 
   17         the training; requiring the school nurse to provide 
   18         followup training and supervision; requiring the 
   19         school nurse or another qualified health care 
   20         professional to provide bus drivers with training in 
   21         the recognition of hypoglycemia and hyperglycemia and 
   22         actions to take in response to an emergency situation; 
   23         requiring the parent or legal guardian of a student 
   24         who has diabetes to submit a copy of the student’s 
   25         diabetes medical management plan to the school; 
   26         requiring a school nurse or trained diabetes personnel 
   27         to perform certain functions regarding a student’s 
   28         care of his or her diabetes; requiring a school nurse 
   29         or one member of the trained personnel to be on site 
   30         and available to provide care to students who have 
   31         diabetes during regular school hours and at school 
   32         sponsored programs and activities; prohibiting a 
   33         school district from restricting the assignment of a 
   34         student who has diabetes to a particular school; 
   35         providing that a member of the trained diabetes 
   36         personnel is not engaging in the practice of nursing 
   37         and is exempt from state law or rule restricting the 
   38         activities of a person who is not a health care 
   39         professional; requiring a school to allow a student 
   40         who has diabetes to manage and care for his or her 
   41         diabetes; providing civil immunity from disciplinary 
   42         action or liability for a school employee, nurse, 
   43         physician, or school district for activities 
   44         authorized under the act; requiring each district 
   45         school board and the governing body of each charter 
   46         and private school to report to the Department of 
   47         Education by a specified date regarding their 
   48         compliance to the act; providing an effective date. 
   49   
   50         WHEREAS, diabetes is a serious, chronic disease that 
   51  impairs the body’s ability to use food as energy, and 
   52         WHEREAS, diabetes must be managed 24 hours a day in order 
   53  to avoid the potentially life-threatening, short-term 
   54  consequences of blood glucose levels that are too high, 
   55  hyperglycemia, or too low, hypoglycemia, and to avoid or delay 
   56  the serious, long-term complications of high blood glucose 
   57  levels, which include blindness, amputation, heart disease, and 
   58  kidney failure, and 
   59         WHEREAS, in order to manage their disease, students who 
   60  have diabetes must have access to the means to balance food, 
   61  medications, and physical activity level while at school and at 
   62  school-related activities, and 
   63         WHEREAS, diabetes is generally a self-managed disease and 
   64  many diabetic students are able to perform most of their own 
   65  diabetes-care tasks, and these students should be permitted to 
   66  do so in the school setting, and 
   67         WHEREAS, some students, because of age, inexperience, or 
   68  other factors need help with some or all of diabetes care tasks 
   69  and all diabetic students will need help if a diabetes emergency 
   70  occurs, and 
   71         WHEREAS, the school nurse is the preferred person in the 
   72  school setting to provide or facilitate care for a student who 
   73  has diabetes, but many schools in Florida do not have a full 
   74  time nurse or a school nurse may not always be available on 
   75  site, and 
   76         WHEREAS, because diabetes management is needed at all 
   77  times, additional school personnel who have completed training 
   78  coordinated by the school nurse and who provide care under the 
   79  supervision of the school nurse need to be prepared to perform 
   80  diabetes-care tasks at school and all school-related activities 
   81  when a school nurse is not available in order for students who 
   82  have diabetes to be medically safe and to have the same access 
   83  to educational opportunities as do all students in Florida, NOW, 
   84  THEREFORE, 
   85   
   86  Be It Enacted by the Legislature of the State of Florida: 
   87   
   88         Section 1. Care of students who have diabetes.— 
   89         (1) DEFINITIONS.—As used in this section, the term: 
   90         (a) “Diabetes medical management plan” means a document 
   91  developed by the student’s personal health care professional 
   92  which sets out the health services needed by the student at 
   93  school and is signed by the student’s personal health care 
   94  professional and parent or legal guardian. 
   95         (b) “Glucagon” means a hormone that immediately raises 
   96  blood glucose levels for severe hypoglycemia. 
   97         (c) “School” means any primary or secondary public school, 
   98  charter school, or private school located within the state. 
   99         (d) School employee” means a person employed by: 
  100         1.A school; 
  101         2.A local health department that assists a school under 
  102  this section; or 
  103         3.Another entity with which a school has contracted to 
  104  perform its duties under this section. 
  105         (e) “Trained diabetes personnel” means a group of school 
  106  employees who volunteer and have successfully completed the 
  107  training required under subsection (3). Such employee need not 
  108  be a health care professional. 
  109         (2) TRAINING OF DESIGNATED SCHOOL EMPLOYEES.— 
  110         (a) The Department of Health shall develop guidelines, with 
  111  the assistance of the following entities, for the training of 
  112  school employees in the care needed for students who have 
  113  diabetes: 
  114         1. The Department of Education; 
  115         2. The American Diabetes Association; 
  116         3. The American Association of Diabetes Educators; and 
  117         4. The Florida Association of School Nurses. 
  118         (b) Training shall be provided annually commensurate with 
  119  the school employee’s role in the student’s care. Training 
  120  guidelines shall include instruction in: 
  121         1. Recognizing and treating hypoglycemia and hyperglycemia. 
  122         2. Understanding the appropriate actions to take when blood 
  123  glucose levels are outside of the target ranges indicated by 
  124  student’s diabetes medical management plan. 
  125         3. Understanding the instructions from the student’s 
  126  personal health care professional concerning drug dosage, 
  127  frequency, and the manner of administration of the student’s 
  128  medication for his or her treatment of diabetes. 
  129         4. Performing finger sticks to check blood-glucose levels, 
  130  checking urine ketone levels, and recording the results of those 
  131  checks. 
  132         5. Administrating glucagon and insulin and the recording of 
  133  doses used. 
  134         6. Understanding how to perform basic insulin pump 
  135  functions. 
  136         7. Recognizing complications that require emergency 
  137  assistance. 
  138         8. Understanding the recommended schedules and food intake 
  139  for meals and snacks, the effect of physical activity upon 
  140  blood-glucose levels, and the proper actions to be taken if a 
  141  student’s schedule is disrupted. 
  142         9. Understanding and operating continuous glucose monitors. 
  143         (c) The Department of Health shall adopt by rule the 
  144  guidelines outlined in this subsection by August 1, 2010. 
  145         (d) Each district school board and the governing body of 
  146  each private school and charter school shall ensure that the 
  147  training outlined in this subsection is provided to a minimum of 
  148  three school employees at each school attended by a student who 
  149  has diabetes. 
  150         (e) A school employee may not be subject to any penalty or 
  151  disciplinary action for refusing to serve as a member of the 
  152  trained diabetes personnel. 
  153         (f) The training outlined in this subsection shall be 
  154  coordinated by a school nurse and provided by the school nurse 
  155  or another health care professional having expertise in the care 
  156  of persons who have diabetes. Such training shall take place 
  157  before the commencement of each school year, or as needed when a 
  158  student who has diabetes is newly enrolled at a school or a 
  159  student is newly diagnosed as having diabetes. The school nurse 
  160  shall provide followup training and supervision. 
  161         (g) The school nurse or another qualified health care 
  162  professional shall provide each bus driver who is responsible 
  163  for the transportation of a student who has training in the 
  164  recognition of hypoglycemia and hyperglycemia and actions to 
  165  take in response to emergency situations. 
  166         (3) DIABETES MEDICAL MANAGEMENT PLAN.—The parent or legal 
  167  guardian of a diabetic student who seeks diabetes care while at 
  168  school should submit to the school a diabetes medical management 
  169  plan that, upon receipt, shall be reviewed and implemented by 
  170  the school. 
  171         (4) REQUIRED CARE.— 
  172         (a) In accordance with the request of a parent or legal 
  173  guardian of a student who has diabetes and the student’s 
  174  diabetes medical management plan, the school nurse or, in the 
  175  absence of the school nurse, trained diabetes personnel shall 
  176  perform functions, including, but not limited to, responding to 
  177  blood-glucose levels that are outside the student’s target 
  178  range; administering glucagon; administering insulin or 
  179  assisting a student in administering insulin through the 
  180  student’s insulin delivery system; providing oral diabetes 
  181  medications; checking and recording blood glucose levels and 
  182  ketone levels or assisting a student with such checking and 
  183  recording; and following instructions regarding meals, snacks, 
  184  and physical activity. 
  185         (b) The school nurse or at least one member of the trained 
  186  diabetes personnel must be on site and available to provide care 
  187  to each student who has diabetes as set forth in this subsection 
  188  during regular school hours, school-sponsored care programs, 
  189  field trips, and extracurricular activities and on buses when 
  190  the bus driver has not completed the necessary training. 
  191         (c) A school district may not restrict the assignment of a 
  192  student who has diabetes to a particular school on the basis 
  193  that the student has diabetes, that the school does not have a 
  194  full-time school nurse, or that the school does not have trained 
  195  diabetes personnel. 
  196         (d) The activities set forth in this subsection do not 
  197  constitute the practice of nursing and are exempt from any 
  198  applicable state law or rule that restricts what activities may 
  199  be delegated to or performed by a person who is not a licensed 
  200  health care professional. 
  201         (5) INDEPENDENT MONITORING AND TREATMENT.—Upon written 
  202  request of the parent or legal guardian and authorization by the 
  203  student’s diabetes medical management plan, a school shall 
  204  permit a student to attend to the management and care of his or 
  205  her diabetes, which may include: 
  206         (a)Performing blood-glucose level checks; 
  207         (b)Administering insulin through the insulin-delivery 
  208  system that the student uses; 
  209         (c)Treating hypoglycemia and hyperglycemia; 
  210         (d)Possessing on the student’s person at any time any 
  211  supplies or equipment necessary to monitor and care for the 
  212  student’s diabetes; and 
  213         (e)Otherwise attending to the management and care of the 
  214  student’s diabetes in the classroom, in any area of the school 
  215  or school grounds, or at any school-related activity. 
  216         (6) IMMUNITY FROM CIVIL LIABILITY.—A physician, nurse, 
  217  school employee, or school district is not liable for civil 
  218  damages or subject to disciplinary action under professional 
  219  licensing rules or school disciplinary policies as a result of 
  220  the activities authorized by this section when such acts are 
  221  committed as an ordinarily reasonably prudent person would have 
  222  acted under the same or similar circumstances. 
  223         (7) REPORTING REQUIRMENT.—Each district school board and 
  224  the governing body of each charter school and private school 
  225  shall annually report to the Department of Education, by August 
  226  15, 2011, and each August 15 thereafter, on whether students who 
  227  have diabetes are enrolled in the school and provide information 
  228  showing compliance with this section. The report must comply 
  229  with the federal Family Education Rights and Privacy Act, 20 
  230  U.S.C. s. 1232g. 
  231         Section 2. This act shall take effect July 1, 2010.