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Kindergarten teacher acts as nurse to diabetic child - legal concerns

Discussion in 'Parents of Children with Type 1' started by iteach, May 13, 2010.

  1. virgo39

    virgo39 Approved members

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    Deafmack,

    Not to start a debate, but I think it is bit of an overstatement to say that if a state does not have law specific to diabetes care that its good samaritan laws would protect the OP or exactly when liability would come into play.

    My understanding is that good samaritan laws vary from state to state in terms of who is covered (the law in my states is limited to specific classes of people, first responders, EMTs, physicians, etc. and those certified in first aid training).

    If it were me, and I was not exempt from liability due to the school relationship, I would consult a lawyer.
     
  2. Marcia

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    I don't have any advice for your questions re legal issues, but I do want to THANK YOU for caring for a child with T1! And then to take the time to come to our website to learn more! As a parent, I can tell you that you are a treasure.
     
  3. Gracie'sMom

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    I also want to say that you are doing a great thing for this child. It is a lot of responsibility but the child can come to school every day and be comfortable and safe because of you. However, for your protection I would look into what it could mean for you legally . . .
     
  4. Sarah Maddie's Mom

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    I'm not going to comment on your use of the term, "uncontrolled" :rolleyes: but getting back to your original question regarding liability, I really can't imagine what advice we could possibly provide on this issue.

    You need to bring this up with your supervisor and get something in writing from them regarding your tasks and your protection from legal action.
     
  5. iteach

    iteach New Member

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    Thank you and some clarification

    ..........
     
    Last edited: May 16, 2010
  6. Sarah Maddie's Mom

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    In your shoes, I'd call my union rep.
     
  7. jules12

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    I agree with previous poster - I would call your union rep. Are you a member? I know that if you are a member of the teacher's "union," they will provide you with legal support -- that is why my husband is a member even though he doesn't always agree with their politics.

    The ADA will tell you what the law says about taking care of a child with diabetes but the NEA will have more specific information about your liability and/or the schools.

    You are great for taking on this role and helping this child. We are fortunate that we have a school nurse part-time and a clerk so my son's teacher doesn't have to take on that much responsibility.
     
  8. roo'smom

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    Unions aren't too common in the south, so I'm guessing that you'll have to deal w/ the administration in regards to liability. Make sure you submit a request in writing (and keep a copy yourself). That way, if you encounter problems/resistance you will have an exact timeline of what went on. Kudos to you for taking on the care of this little girl!
     
  9. Flutterby

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    I know you are worried about legal aspect of it all.. I just want you to know that you are probably a huge relief to this child's family.. knowing that her teacher knows what to look for and how to treat is probably a huge relief.. yes, its not part of your job but you are helping this mother out big time.

    ANY child with type 1 diabetes is going to go low and high, thats the nature of this disease.. little ones are often insulin sensitive and carb sensitive.. so any little amount of insulin drops them a lot and a little amount of carbs can raise their blood sugar a lot.. younger children usually do have this problem.. my own still does and she's not in any more danger than any other child with type 1. A child with what looks to be 'steady' blood sugar is still fluctuating, they are still having highs and lows.. they can still go dangerouly high and dangerouly low.

    I think taking the advice about and going to the union rep and asking them on their advice is a good thing. I also think what Becky (Lee) said is true.. the administration put you in this position, you should protected under the school. I don't know what the 'laws' are in NC, but if its stated that school personal can be trained to take care of a child with diabetes,then you should be all set.
     
  10. GaPeach

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    It sounds like you have great communication with the mother. I bet she would be open to discussing trends with you.

    I guess you figured out from responses that we parents can get a bit touchy. :( BUT most do appreciate anyone who has a genuine concern and willingness to help in care for our child. :cwds:



    Great insight!!!

    Wild swings are no fun. Most children feel badly and are impacted physically and emotionally by swings. The best part of pumping insulin is that swings can be managed to a greater degree.

    Yes, numbers will flucuate - BUT I agree with Wilf that the swings could be managed a bit more.

    It sounds like you have an open line of communication. The above suggestions are great!


    I am so glad that you found the CWD forum. Again, I commend you on being willing to serve. I cannot imagine a Kindergarten teacher having the time to be so involved with her care. I understand that in some ways you have no choice.

    As you mentioned, we parents have no medical degree either. It was a bit overwhelming to have a child that was admitted to the hospital's ICU - released back to us 5 days later with minimal instruction. The reality is that our child's life is in our hands. The endo team does provide support but the day-to-day management falls completely upon us.

    I am APPALLED that the school administration is not providing clear instruction in regard to your liabilty.

    This summer I reccommend 3 books:
    Type 1 Diabetes: A Guide for Children, Adolescents and Young Adults -- and Their Caregivers by Ragnar Hanas, M.D
    Think Like a Pancreas: by Gary Scheiner
    Pumping Insulin by John Walsh

    Although you would not be making any changes to your student's care plan, the information you glean from these books will allow you to have even better communication with the mother.

    JUST IN CASE you didn't get the message - You are an ANGEL!!!!!
     
    Last edited: May 17, 2010
  11. mcleodja

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    I am quite suprised with the amount of people thinking negatively about this teacher. A teacher who takes this attitude is worth 10 nurses anywhere because it is the classroom it all happens and a nurse that is only present one half day per week might as well not be present atall. Secondly if the child is indeed going into the 500's there is a need to be concerned because the teacher will probably be having to deal with ketones etc... and this does affect the ability of the child to actually learn in the classsroom. I can remember just before my daughter was diagnosed that the teacher was indicating attention problems, attitude problems, crabiness etc... all because it was undiagnosed diabetes and dka. I assume any child hitting the 500 mark is bordering on dka if this teacher was not so caring and would have a very hard time focusing, listening and having to run to the bathroom alot.

    I commend this teacher and wish there more like you and don't let some of the snarky comments on this thread get to you because many times these people just have issues.
     
  12. hawkeyegirl

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    I agree. I am the mother of a child in K, and I cannot imagine asking Jack's teacher to provide basically 100% of his care. That is simply not her job. The administration should really have someone else doing to vast majority of this child's care. I have no idea how you are supposed to teach effectively and manage a child's diabetes effectively. It seems very, very unfair to you (and a little unfair to the rest of the class).

    I agree that you should talk to your union rep. I think your liability concerns may well be valid, and, again, you are a teacher. You should be allowed to teach.

    Finally, I do commend you for taking on this role, even though I don't think you should have to. These parents and this child are lucky to have you. :)
     
  13. Christopher

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    Welcome, I just wanted to echo that I think it is great that you came here looking for advice. And it is commendable the time and energy you are putting into caring for this child. Most children with diabetes are seen by their endo (on average) once every 3 months. If this child is seen 3 times a month that is unusual, in my opinion. Clearly there are other issues going on here that we don't know about.

    I understand your worry about your liability and am sorry your administration is not assisting you. You have gotten some great advice above and I hope you can get it sorted out. I like your idea about talking to the school system attorney, that seems like a very reasonable thing to do. Hopefully your administration will understand that you are just looking out for yourself, which no one should be faulted for.

    My final comment is that you may want to consider sharing this site with the parents of the child. If you present it in the context that you found a great site for support and information I think they would appreciate it and not take it the wrong way.

    Good luck and thank you for all that you do. :cwds:
     
  14. madde

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    Just thinking out loud....wouldn't the liability fall back on the administration for not hiring a full-time nurse, LPN and putting them in charge of this child's diabetes care?

    I think the parents should really push the school to hire a trained professional.

    BTW, you are an awesome individual to be so concerned with this child.
     
  15. Lee

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    I am surprised that people see anything in this thread that is negative against the teacher. The ONLY negative this I said was in response to WILF to talk to the parent. We did not have enough information at the time to even comment on how involved mom was. And she came back and said Mom is very involved!

    I have gone back and reread my posts and other posts and I see no negativity at all. This teacher's main concern is liability - and that is what I have tried to address.

     
  16. mcleodja

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    I did not mention names but just referring to the persons who essentially say, " how dare a teacher ................"
     
  17. denise3099

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    I'm coming to this discussion late and I didn't read every single post, but I just want to say that you are awesome!!!! My dd was dx at 4 in preschool. The owner of the preschool happened to be an older woman with T1 since she was 19. Lucky for us, b/c she allowed/encouraged the staff to help with my dd's care. DD was in preschool all day with no nurse. Her teacher checked her bs before lunch and called me to tell what she ate and get dosing instructions. She also checked whenever dd didsn't feel well and at other times. She had uncovered snacks at the time. Having a dedicated teacher care for my child was a blessing.

    If you notice patterns or are having a difficult time manages a certain situatin then, yes you should talk to the parents, just to say, hey I notice this pattern, so what should I do when . . .? I'd be really surprised by any parent who had a hard time with a teacher of a young child wanting to discuss ANY problem the kid was having! If you notice my kid squinting, tell me! if you notice she doesn't eat her lunch, tell me!! if you notice she has tummy aches every morning, tell me!!! You're with her all day and she's so young, teachers must be able to discuss a child's problems with the parent!!!! Teachers of little kids often are the first to notice things like tummy aches, bathroom problems, needing glasses, etc.

    Re liability, I have no advice. The parent has elicited your help in manageing care and if you follow the plan and her instructions, then I don't see you being liable for anything.

    Awesome job, Teach!!!
     
  18. virgo39

    virgo39 Approved members

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    You didn't say, but I'm assuming that you teach in a public school. If that is the case, it looks like this statute would provide protection for your actions in caring for this student (emphasis added):

    http://www.ncga.state.nc.us/enactedlegislation/statutes/html/bysection/chapter_115c/gs_115c-375.1.html

    Article 25A.

    Special Medical Needs of Students.


    115Cā€‘375.1. To provide some medical care to students.

    It is within the scope of duty of teachers, including substitute teachers, teacher assistants, student teachers, or any other public school employee when authorized by the board of education or its designee, (i) to administer any drugs or medication prescribed by a doctor upon written request of the parents, (ii) to give emergency health care when reasonably apparent circumstances indicate that any delay would seriously worsen the physical condition or endanger the life of the pupil, and (iii) to perform any other first aid or lifesaving techniques in which the employee has been trained in a program approved by the State Board of Education. No employee, however, shall be required to administer drugs or medication or attend lifesaving techniques programs.

    Any public school employee, authorized by the board of education or its designee to act under (i), (ii), or (iii) above, shall not be liable in civil damages for any authorized act or for any omission relating to that act unless the act or omission amounts to gross negligence, wanton conduct, or intentional wrongdoing. Any person, serving in a voluntary position at the request of or with the permission or consent of the board of education or its designee, who has been given the authority by the board of education or its designee to act under (ii) above shall not be liable in civil damages for any authorized act or for any omission relating to the act unless the act amounts to gross negligence, wanton conduct, or intentional wrongdoing.

    At the commencement of each school year, but before the beginning of classes, and thereafter as circumstances require, the principal of each school shall determine which persons will participate in the medical care program. (2005ā€‘22, s. 2(b); 2006ā€‘264, ss. 57(a), (c).)​
     
  19. CAGrandma

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    I am amazed that the school would blow you off like that because it sounds to me like they are the ones leaving themselves open to any legal action - not you. It is the school district's responsibility to provide diabetes care to the student. They could have arranged for a full time nurse to provide that care (yes, I know that is not always possible) but instead they are authorizing you to act as their agent in providing the care according to the 'care plan'. I'm not sure what exactly the 'care plan' is, or how detailed it is, but I would suggest that the mother have a formal 504 plan in place. Include in that 504 that you could/should follow instructions provided by the mother, etc. It should also state that others at school be trained as well as you.

    When you act as an agent of the school, which is what you have been doing, it doesn't matter if it is as a teacher or as a diabetes care provider - they are the ones responsible unless you do something particularly reckless or negligent. The only legal problem I would worry about is if you have been providing diabetes care and the school administration was unaware of that. So be sure there is something in writing that recognizes the reality that the school wants you to be doing this (the 504) so the school admin can never claim they only wanted you to do blood glucose checks, for example, and all the rest was your idea.

    I am a bit concerned that if you push this issue with school admin and particularly with their legal people, someone will realize that they are the ones who might be at risk and all of a sudden they will decide that you can't do anything for this child. Which would be such a shame - you are just what that child and her family need. Many schools do refuse to allow teachers to provide insulin and expect family members to come to school to do that - in spite of the fact that it is in violation of federal law. So I hope you hang in there!
     
  20. Lisa P.

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    I've been a mom and a teacher so I'm going to add my 2 cents, but please feel free to ignore it if it doesn't apply well to your situation.

    The interaction between school caretakers and parents can be complicated. I would encourage you to try very hard not to make assumptions about the home care of this child. If you are seeing unacceptable highs and lows and school, that does not necessarily mean they are common at home. It is very difficult to keep bg even in an environment where there is not one on one and perpetual care, where food is normally full of pretty high and fast carbohydrates, where exercise is inconsistent (long periods of sitting followed by sharp rises in activity, over and over). I would suggest that if you'd like to see better numbers at school that you take the approach of asking how the child can be treated differently while at school, instead of assuming the entire diabetes care program has a problem.

    As an example, highs are almost unavoidable unless you prebolus --meaning that you give the insulin some time before the child eats. As a parent, I would not want an overtaxed kindergarten teacher who is already doing so much for my child burdened with the responsibility of prebolusing. It is a lot to ask, and if they are already grateful for what you do and realize you are putting yourself on the line liability-wise, they probably won't ask you to do it. (If a child is prebolused and then something interferes with eating, the child will probably have a dangerous low and potentially seizures and hospitalization).

    They may feed foods at home that are low on the glycemic index but don't want to ask you to alter the diet of your class. If your class has juice for every snack (as I've seen many kindergartens do to get nutrients into the kids) your student will go very, very high every time she drinks it, for example. The parents might not want to burden you with changing your routine, or may not want the child to feel differentiated from her peers. Essentially, they tolerate the swings in bg as a way to compromise with a school lifestyle.

    I would suggest that if you want to improve the child's care at school that you approach the issue as one a school issue -- not an issue of the overall care of the child. If you take the approach of "hey, we're not seeing the numbers at school that I'm sure you'd like to see, what can we do to change outcomes on our watch" instead of "this child's diabetes care overall is not doing the trick" you will have greater success.

    As for liability, the district should have a lawyer you can meet with. I would have had concerns, also. However, I have never heard of a teacher being prosecuted for a medical mistake. I think the danger of litigation is exaggerated; but I can certainly see not wanting to even take on a small risk of lawsuit for your job, when you are doing the best you can.
     

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