Tuesday, May 30, 2017

U.S.Attorney Agreement With The NY State Education Department To Change State Guidelines On Parental Involvement In Medication Adjustments At School For Children With Diabetes

  Joon H. Kim, the Acting United States Attorney for the Southern District of New York, announced today that the United States has resolved its investigation into complaints alleging that the New York State Education Department (the “NYSED”) violated Title II of the Americans with Disabilities Act of 1990 (the “ADA”), 42 U.S.C. §§ 12131-12134, and related regulations by refusing to permit parent and guardian involvement in the adjustment of a child’s diabetes medication, with the approval of the child’s doctor, during school or at school-sponsored events.
Acting U.S. Attorney Joon H. Kim said: “Parents of children with diabetes have a right to play a role in the treatment of their children while at school. We are pleased to have reached an agreement with the New York State Education Department that will help students with diabetes receive during school the same adjustments to their medication that they receive outside of school, as their doctors direct.”
This Office’s investigation found that, in September 2015, the NYSED issued Guidelines for Medication Management in Schools that caused schools to reject certain types of orders issued by physicians treating children with diabetes authorizing parents and guardians to be involved in the adjustment of their child’s diabetes medication administered by the school healthcare team. The rejected orders included model orders developed by national diabetes organizations such as the National Diabetes Education Project and the American Diabetes Association by which a physician could authorize a parent or guardian to direct a school healthcare professional to adjust, within limits, the dosage and timing of correction doses of insulin, insulin-to-carbohydrate ratios, and fixed insulin doses. As these model orders reflect, it is common for parents and guardians of children with diabetes to have particularized knowledge with respect to their child’s recent activities, food intake, reaction to medication, and the like, and, through training and experience, to develop expertise regarding the adjustment of the dosage and timing of their child’s diabetes medication, information that is essential to the provision of necessary medical care for children with diabetes at all times, including at school. The investigation found that the Guidelines were hindering the communication of this vital information and in certain instances preventing necessary adjustments to diabetes medication from occurring at school. This Office detailed its conclusions in a Letter of Findings dated January 18, 2017.
In response to the investigation, the NYSED agreed to amend the Guidelines. The NYSED has also agreed to provide a model form for a physician to use to authorize the involvement of the parents/guardians in adjustment decisions where appropriate. The final decision with respect to the dosage and timing of diabetes medication shall remain with the school nurse as a matter of the nurse’s exercise of professional judgment, which will include consideration of the information communicated by the parent or guardian.
Specifically, under the resolution, NYSED has agreed to take the following actions: (i) amend the provisions of the Guidelines that were identified by the investigation as causing concerns; (ii) include additional language in the Guidelines explaining the respective roles of the school nurse and the parents/guardians who have been authorized to recommend adjustments of their child’s diabetes medication within specified limits; and (iii) provide a link to a model form through which physicians can provide such authorization to the parent/guardian (provided that the student’s Diabetes Medical Management Plan also includes authorization of the school nurse to make adjustments within the same range(s) as a matter of the nurse’s professional judgment). These changes, which resolve the issues addressed in the Letter of Findings, are explained in more detail in the attachments to the Office’s resolution letter. An amended version of the Guidelines reflecting these changes appears on the NYSED website at the following address: http://www.p12.nysed.gov/sss/schoolhealth/schoolhealthservices/.
Mr. Kim also thanked NYSED for its cooperation. The case is being handled by the Office’s Civil Rights Unit. Assistant United States Attorney Michael J. Byars is in charge of the matter.

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