Oops, That Wasn't a Cell Phone, It Was His Substitute Pancreas

GUEST BLOGGER Sarah Blenner

As Clifton Hassam, a Florida 16 year old junior in high school, sat in class, his blood sugar began to reach dangerous levels.  His monitor, which is attached to his hip, began beeping to inform him of this.  Hassam reached down to turn off the beeping noise and take care of his blood sugar levels.  However, the substitute teacher, believing that Hassam had a cell phone, the use of which during the school day is forbidden, reached down and grabbed the device, pulling out the tubing from Hassam's waist and disconnecting the insulin pump.  It took several days before Hassam's blood sugar reached normal levels again.

Hassam was diagnosed with diabetes when he was six years old.  Like many other individuals with type-1 diabetes, Hassam manages his diabetes in part by wearing an insulin pump, a device that is designed to notify Hassam when his blood sugar reaches unhealthy levels.  According to Hassam, the pump is “my whole life on my side.” The device is about the size of a pager and has a tube (or catheter) that runs under the skin and into the blood stream.  The pump not only monitors blood glucose levels, but it also releases fast acting insulin directly into the blood stream just as a pancreas in a body with normal pancreas function would release insulin into the blood stream.

Unfortunately, Hassam is not the only student whose insulin pump has been confiscated during school hours because of a lack of understanding on the part of school officials.  In 2002, a Florida middle school assistant principal made a student turn over her insulin pump in the cafeteria because the assistant principal believed that it was a pager.  Despite the fact that the student wore a medical identification bracelet and despite the fact that the student's parents had filed health plans with the school, the assistant principle kept the insulin pump for at least twenty minutes.  As a result, the middle school student became sick later that day and was admitted to the hospital with an infection the next week.  The event was so traumatic to the middle school student that she had not returned to using the insulin pump even two years later and instead opted to self-administer shots of insulin up to eight times in one day.  When her parents took legal action against the school, a settlement was reached consisting of, among other things, a $10,000 payment to the family and an agreement to provide educational training to principals and staff who provide medical assistance to children who have diabetes.   Since as early as 2002, Florida law has required unlicensed school employees to be trained if they will administer medication or if they will assist a student with diabetes check his or her blood glucose levels.  However, there is no state law that requires general diabetes training to school employees (including any general education on insulin pumps).   But is it really enough to provide training to only principals and those who are going to provide medical assistance to the children?

As a result of such incidents, some states have passed laws addressing the education of school employees about diabetes.  Seventeen states have statutory provisions regarding diabetes-related training programs for school employees (Alaska, California, Florida, Hawaii, Indiana, Kentucky, Montana, North Carolina, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, and West Virginia).  Seven additional states have statutory provisions regarding training school employees on the care of chronic illnesses more generally, which by nature of a chronic illness should include diabetes training (Delaware, Iowa, Louisiana, Maine, Nebraska, Ohio, and Vermont).

These statutes address various issues of educational training including the minimum number of people trained, the topics covered during training, which employees are trained, who should conduct the training, the frequency of trainings, and whether the sessions are mandatory for the school to provide or required for employees to attend.

Texas has one of the most comprehensive statutes requiring training of some school employees in its Health and Safety Code.  Schools in Texas that have at least one student with diabetes enrolled are required to provide a minimum number of people who are trained in diabetes care during school hours.  These individuals are referred to as unlicensed diabetes care assistants.  If the school has a full time nurse, then the school must make an effort to provide at least one trained unlicensed diabetes care assistant.  If there is not a full time nurse, then the school must make an effort to provide at least three trained unlicensed diabetes care assistants.

In Texas, diabetes care assistant training must include: (1) how to recognize symptoms of hypoglycemia and hyperglycemia; (2) what to do if the student's blood glucose level falls outside of his target range; (3) how to understand a student's individualized health plan; (4) how to perform a blood glucose level check; (5) how to perform a urine ketone level check; (6) how to record results of the glucose and ketone tests; (7) how to properly administer glucagon and insulin; (8) how to record administration of glucagon and insulin; (9) how to recognize complications that require emergency assistance; (10) how to understand the recommended schedule and food intake; (11) how physical activity effects blood glucose levels; and (12) what to do if a student's schedule is disrupted.

In addition to requiring training of unlicensed diabetes care assistants, the Texas statute provides that school employees must be provided with an information sheet about the student with diabetes if they provide transportation to the student with diabetes or if they are responsible for that student on an activity that takes place off-campus. The information sheet provides pertinent information such as the student's name, any potential emergency situations, what the appropriate response should be, and any emergency contacts.

In the school setting, school employees (nurses and non-nurses alike) often make mistakes that have severe health consequences for a child with diabetes.  Whether this “mistake” is tearing out an important monitoring device such as the insulin pump, feeding a child food when his blood sugar is high (as opposed to the correct response of administering insulin), preventing a child from going to the bathroom or accessing the water fountain, or letting a child with blood sugar levels that are perilously high (to the point that it has induced vomiting) off the bus without any supervision and blocks from home.  The solution to the problem is simple.  If school employees are properly informed, misunderstandings are less likely to occur and students are more likely to be safe, healthy, and free from embarrassment.

Sarah Blenner is a second year law student at Chicago-Kent College of Law and a first year public health student at University of Illinois at Chicago.  She received her Bachelor of Arts with high honors from Emory University in May 2007, where she studied Jewish Studies and Anthropology.  Sarah has been a research assistant at the Institute for Science, Law and Technology since May 2008 and has also worked for the Chicago-Kent Health and Disability Law Clinic.  Her interests lie in the intersection between health, religion, and the law.

Comments

[Paula]

Hi Sarah,

Well written diabetes article there. I used to work in health care and in particular with type two diabetics and some type 1 and I know too well of the challenges that diabetes can cause, especially insulin dependent diabetics as you have referred to here.

There is more technology being developed for insulin delivery which is meant to replace things like pumps that people have to wear.

But I agree that teachers should be educated on diabetics students needs, as I can semi understand them not understanding.

Kind regards,

Paula Tomlin