Requiring nurses to give shots in schools questioned

SAN FRANCISCO —  Several members of the California Supreme Court appeared wary Wednesday of requiring public schools to provide licensed nurses to administer insulin injections and other medications to schoolchildren.

The powerful California Nurses Assn. has argued that state law requires licensed nurses to provide insulin injections and other medicines, and two lower courts have agreed. The American Diabetes Assn. appealed. During a hearing, some justices on the state high court appeared skeptical of the nurses’ arguments.

Justice Ming W. Chin, noting that few schools have full-time nurses, questioned why districts should have to call in a licensed practitioner to administer a shot that a child’s parents and physician have agreed could be given by an unlicensed but trained employee.

“You have this bureaucratic nightmare,” Chin said.

Justice Joyce L. Kennard asked why the state would prohibit a trained employee from giving an insulin shot “when even a child who is not too young can administer himself or herself.”

The court is considering a ruling by Chief Justice Tani G. Cantil-Sakauye, who wrote a unanimous decision in favor of the nurses when she served on a lower appellate court. Because of her prior ruling, she was replaced on the case by Presiding Justice William R. McGuiness of the San Francisco-based Court of Appeal.

Cantil-Sakauye’s ruling included a concurrence from a justice who said he was following the law reluctantly, and questioned whether it was “the product of legitimate concern for the safety of diabetic public school students or the result of a labor organization protecting its turf and flexing its political muscle.”

Dennis Maio, an attorney for the diabetes association, said state law should be interpreted to permit a trained, unlicensed and designated school employee to administer insulin shots when the parents have consented and a doctor has ordered them.

California has 10,000 public schools, and 95% of them do not have a full-time nurse, said Maio, also representing the Disabilities Rights Education and Defense Fund.

If the law were interpreted as nursing groups say it must be, then a school employee would be unable even to take a child’s antibiotics out of a cupboard or remove a safety cap from a pill bottle, he said.

But Justice Kathryn Mickle Werdegar noted that the court was required to interpret existing law, not to make policy.

Justice Carol A. Corrigan asked whether a parent must be summoned from a job to school whenever his or her child needed an injection. Both sides in the dispute agree that parents may inject their children at school and capable students may inject themselves.

Maureen E. Cones, representing nursing groups, said parents could not be required to give their children injections at school.

“They absolutely need to provide a licensed caregiver,” she said.

Kennard reminded her that many schools have tight budget constraints. “You don’t perceive any huge financial burdens on the schools?” Kennard asked.

Cones replied that schools should make healthcare a priority and observed that the seven-member Supreme Court was bound to follow laws passed by the Legislature.

“The law says what it says, and only the Legislature can change the law,” Cones said.

California’s Nursing Practice Act prevents unlicensed persons from performing the functions of nurses, including treatment that requires substantial scientific knowledge and technical skills. The law lists the administration of medication as a nursing function.

The diabetes association pointed to a section in the law that allows any person to follow a physician’s orders as long as that person does not assume the role of a nurse. The Court of Appeal ruled the exception had to be read narrowly because otherwise the rest of the law would be rendered meaningless.

The Supreme Court must interpret the nursing law and reconcile it with the state education code, which permits school personnel to assist students with medication. The appeals court said assistance did not include administering medication.

The case reached the state high court following a class-action lawsuit against the state by the diabetes association and diabetic students. The court’s ruling is due within 90 days.

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maura.dolan@latimes.com