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[IP] D article on CNN.com

Thought all of the POP's would be interested in

Diabetic children adjust to school without nurses
Monday, June 9, 2003 Posted: 8:45 AM EDT (1245 GMT)
SAN FRANCISCO, California (AP) -- When 7-year-old
Aaron Kovsky was diagnosed with juvenile diabetes, his
father called the school to explain his son's new
medical regimen. 

Aaron would need to prick his finger four times a day
to test his blood sugar, and give himself a shot of
insulin if his sugar was elevated. And if Aaron's
sugar level ever fell too low and he lost
consciousness, he'd need an emergency shot of the
hormone glucagon. 

But Steve Kovsky learned there was no nurse in Aaron's
school or any other elementary school in Moraga, an
affluent suburb of San Francisco. And the district
superintendent and school principal refused to
authorize other staff members to administer glucagon,
saying they lacked sufficient medical training. 

"We determined school was not a safe environment for
Aaron," Kovsky said. "So we brought him home. It was
traumatic for him, and traumatic for us." 

It's a crisis facing millions of children with
diabetes and other chronic health conditions across
the country, as cash-strapped school systems eliminate
nurses along with other "nonessential" positions. Last
year, there was just one school nurse for every 3,521
students, according to the National School Nurses

In California, only 5 percent of schools had a
full-time nurse this year, down from 7 percent in
1998, according to surveys by the California State

Moraga's elementary schools lost full-time nurses 20
years ago, relying instead on nurses from the high
schools for emergencies. But budget cuts are forcing
layoffs of two of the five remaining nurses this year,
said superintendent Rick Schaefer. 

As the number of students with serious medical needs
and drug prescriptions grows, untrained school
personnel -- often secretaries, clerks or coaches --
are being asked to perform duties from dispensing
Ritalin to giving epinephrine shots for bee-sting

"When you look at the kinds of medications
administered every day in school, it's incredible and
scary," said Nancy Spradling, executive director of
the California School Nurses Organization. 

"Asthma rates are way up. Diabetes is way up. And a
lot of kids were born as preemies who would not have
survived 10 years ago, giving us some medical issues
we're not prepared to deal with," she said. 

The federal Americans With Disabilities Act, passed in
1990, requires public schools to offer full access to
education for children with special medical needs. But
the mandate carries no funding, and many school
systems struggle to comply. 

Children with Type 1 or juvenile diabetes, like Aaron,
often present the biggest challenge. They need to
monitor themselves carefully to avoid long-term damage
to the eyes, kidneys, nerves and heart. And in the
rare instances when their blood sugar drops suddenly,
quick intervention is needed to prevent a hypoglycemic
coma from causing brain damage or death. 

But many teachers' organizations and school
administrators balk at taking responsibility, citing
liability concerns and lack of medical training. 

They are "concerned that someone who maybe doesn't
have the correct training could end up hurting a
child, just by trying to do the right thing," said
Leslie Getzinger, a spokeswoman for the American
Federation of Teachers. 

Insulin can cause irreversible brain damage if
administered incorrectly. While children over the age
of 7 can generally give themselves insulin shots, most
states forbid anyone else but a registered nurse to
administer the injection. 

At least five states -- Virginia, North Carolina,
Washington, Tennessee and Wisconsin -- have laws or
executive orders to provide some coverage for diabetic
youngsters where there are no school nurses. Most
involve administration of glucagon, which poses no
health risk. Only Virginia allows non-medical
personnel to be trained to administer insulin. 

Aaron Kovsky stayed out of school for a week and a
half, until the district agreed to hire a certified
diabetes educator to train the principal, secretary
and Aaron's teacher to give him a glucagon shot if he
needs it. 

But Schaefer and others said such solutions don't
replace the value of a school nurse in dealing with
children's emergencies. 

"When I went to school, there was a nurse, Miss
McDonald," said Francine Kaufman, a pediatric
endocrinologist and outgoing president of the American
Diabetes Association. "She had the whole white outfit,
and the hat. But Miss McDonald doesn't exist anymore,
and it's a problem. 


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