Diabetes - Unique Problems and Legal Protections in School

Diabetes is recognized as a disability by the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act. Students with diabetes are also specifically protected by Florida law. These state and federal laws outline the rights and responsibilities of students with diabetes and their parents.

Florida Statute 1002.20(3)(j) states that a school district may not refuse to assign a student to a school on the basis that the student has diabetes, that the school does not have a full-time nurse, or that the school does not have trained diabetes personnel.

Florida law further states that a student with diabetes (with parent and physician authorization), may carry diabetic supplies and equipment. Students may also manage and care for their diabetes while in school, participating in school-sponsored activities, or in transit, to the extent authorized by the parent, physician and State Board of Education rule.

Florida law governs how non-medical personnel may assist. According to the Florida Department of Health, Florida's Nurse Practice Act allows nurses to train and delegate insulin administration to unlicensed school personnel where the person has demonstrated competence in blood glucose monitoring and insulin administration. To read further on this topic, visit the Links tab to access the Department of Health's Nursing Guidelines for the Delegation of Care for Students with Diabetes in Florida Schools from the Department of Health's School Health Services Program website.

Parents do not have the right to insist that insulin administration be performed by a nurse at school, but they do have the right to require that it be performed by an appropriately trained adult.

In summary, Florida law:

Parents and self advocates should be familiar with their rights and responsibilities under the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act. A student with diabetes must have at least a 504 Plan. If the student is also eligible for special education under IDEA, they must have an Individualized Education Program (IEP) and the diabetes issues may be covered by that plan instead.

  • forbids school districts from transferring children with diabetes due to diabetes or a need for diabetes services.
  • places responsibility on school districts to find and train sufficient staff to meet the needs of students with diabetes.
  • allows unlicensed personnel to be trained to administer emergency injectable medication, such as glucagon.

Written Authorization

The written authorization from the parent and doctor needed to allow a student to carry diabetic supplies and equipment and perform activities without assistance must identify the supplies and equipment and describe the activities. These activities may include performing blood-glucose level checks, urine ketone tests, administering insulin through the delivery system used by the student, and treating hypoglycemia and hyperglycemia.

Individualized Health Care Plan

Florida law requires that each student's doctor's orders be prepared on a Diabetes Medical Management Plan (DMMP) form. The DMMP (or a seperate signed document) is also where the doctor should explain the extent to which the student's diabetes care can be performed by trained unlicensed school personnel.

Florida law also requires that each student with diabetes have an Individualized Health Care Plan (IHCP). An IHCP explains how the DMMP will be implemented and includes things like an Emergency Care Plan explaining step by step what school personnel should do in an emergency.

IHCPs should be developed by the school's registered nurse. Every school has an RN assigned, whether or not that RN works there full time. The student's 504 Plan or IEP should incorporate the IHCP by reference.

The Department of Health also recommends that a Brief Alert or Health Alert  be written and provided to the school personnel who might interact with the student.

Development of the IHCP should be a collaborative process between the RN and the parent based on the doctor’s orders (DMMP). It is acceptable for the nurse to prepare an IHCP in advance and present it to the parent. But parents should not sign an IHCP they disagree with. Instead, the nurse should call a meeting with the parents and the doctor to work together to write an agreeable plan.

These documents and procedures are described in detail in the Florida School Health Administrative Guidelines found on the Department of Health's School Health Administrative Guidelines website.

Supports, Services and Accommodations

The student's 504 plan or IEP should also list and describe the supports, services, and accommodations needed by the student.

Common accommodations include access to testing supplies, snacks, water, bathroom breaks, and testing accommodations.

It is important that one of the accommodations related to testing be that the student's blood sugar levels be checked prior to any major test or exam, particularly a standardized test, to make sure their blood sugar level is in the healthy range as specified by the doctor on the DMMP.

Possible Rights Violations

The following is a list of possible rights violations that parents, self-advocates and others should be aware of:

  • No Individual Health Care Plan (IHCP) developed
  • Denial of coverage under 504 and refusal of a 504 Plan
  • Denial of student's participation in extra-curricular activities and field trips
  • Requiring parent to go on field trips or provide coverage during extra-curricular activities
  • Refusal of needed accommodations on 504 Plan
  • Requiring all diabetes management to take place in health clinic resulting in lost educational time
  • Requiring transfer to a school with full time nurse
  • Requiring parent to provide insulin administration
  • Pushing student to self-manage before they are really ready
  • Pressure for the doctor to change the student's diabetes regimen to accommodate school
  • Refusal to have all staff that will be responsible for the student trained in general and student-specific diabetes care
  • Refusal to provide an appropriately trained adult to serve as back up to the staff person regularly assigned to provide the insulin administration
  • Refusal to allow participation in certain school activities
  • Refusal to honor accommodations listed on the student’s 504 Plan, such as asking the student to take the FCAT when they are not within the required blood sugar range

As previously mentioned, parents and self-advocates should be familiar with their rights under Florida law as well as under the IDEA and Section 504.

Please visit these Disability Rights Florida's Disability Topics pages for more information about IDEA and Section 504.

Or go directly to the U.S. Department of Civil Rights website and enter a search for Section 504 and for diabetes.

If you believe your child's rights have been violated, you may contact Disability Rights Florida to request assistance.

Links

To learn more visit these websites: