In response to a challenge by the American Nurses Association of a legal opinion from the California Department of Education, the California Supreme Court ruled August 12 that unlicensed school employees have authorization to administer insulin to diabetic children if doing so on the orders of a doctor
(American Nurses Association, et al. v. Torlakson).
Although federal law entitles diabetic school children to have someone administer insulin while at school, 26 percent of California’s schools do not have a nurse on staff to administer those injections. The shortage makes administration of insulin difficult and, in 2005, four diabetic students from the city of Fremont filed a class action suit against the state for failing to adhere to the law.
As part of a settlement with the students who filed the lawsuit, the state’s Department of Education issued a legal advisory opinion in 2007, which, among other things, authorized unlicensed school employees to administer insulin to students if instructed by a doctor to do so.
Shortly after the opinion was issued, the American Nurses Association (ANA) challenged it in court as promoting the unlicensed practice of nursing. The lawsuit prompted the American Diabetes Association to become involved, and it issued its own legal complaint seeking to dismiss the suit.
The ANA’s challenge met with initial success when a trial court invalidated the section of the opinion that authorized injections by non-nurse employees. However, the American Diabetes Association appealed and the case eventually went up to the Supreme Court, which issued an opinion written by Justice Kathryn Werdegar.
Although an important issue, the case was unusually more cut-and-dried than a typical case meriting a published opinion from a state supreme court. California statutes, which regulate the administration of medicine at school, expressly allow for students to be assisted by nurses or “other designated school personnel” and the issue actually had a lengthy regulatory and enforcement history.
Further, the judge wrote, the state’s Nursing Practice Act itself allows for unlicensed individuals to administer care to a patient prescribed by a physician as long as the person does not purport to be a professional nurse.
The ANA proffered differing interpretations of the law—arguing, for instance, that an individual acts as a nurse by performing nursing activities. But Werdegar did not agree. If the Nursing Practice Act were to be interpreted that way, she wrote, the Act’s own exceptions would be meaningless.