Concerns and Clarifications

1.   This is just another sweeping, unfunded state mandate.
No. The mandate is federal and compliance in Illinois is so poor, in fact, that the Department of Education recently concluded that Illinois "needs assistance implementing the requirements of the IDEA," which is the Individuals with Disabilities Education Act, first enacted in 1970. Two other federal laws also apply: Rehabilitation Act of 1973 (often referred to as Section 504) and the Americans with Disabilities Act of 1990 • The incidence and prevalence of Type 1 diabetes is such that the number of children who will require assistance with diabetes care in school is very small. This means not all schools will be called upon to implement a Diabetes Medical Management Plan • Given the limited scope of the bill, HB146 is anything but sweeping. With more than $1 billion in federal special education grants and Title I funds allocated to Illinois, the provisions of HB146 are hardly unfunded.

2. There's no need for state law because federal law exists.
No. HB146 is needed because there is a link missing between between federal law and local enforcement. This disconnect forces parents to be the sole enforcers of federal law, which means that students' rights are dependent upon their parents ability to file and campaign civil rights complaints or federal lawsuits. This asymmetrical enforcement system results in discrimination. By providing a baseline protocol of care tasks, HB146 provides the specificity needed to ensure that the rights of all students with diabetes are protected, not just a few.

3. The provisions of HB146 can be achieved through regulation.
Yes and No. Regulations could have affected the provisions of HB146. However, controlling federal law has been in effect for more than 30 years. If statewide regulations were going to be promulgated, it's reasonable to conclude that after more than three decades appropriate health policy could have been developed, even refined. Instead, opposing stakeholders continue to argue about the applicability of federal law, the locus of policymaking and a union-preferred staffing mandate.

4. HB146 precludes schools from local policy making.
Yes and No. The preference for local control over school policy is best suited for localized issues but has not proven effective for implementing federal mandates related to disability issues, particularly diabetes care. The primary purpose of HB146 is to improve compliance by resolving the structural impediments and signaling the State’s interest in complying with federal law, case law and OCR findings • HB146 provides a baseline, the minimum standard that must be met. Individual schools and districts are free to develop personalized programs and services that exceed the minimum standards set out in HB146.

5. There are too many liability issues involved with HB146.
No. Opponents argue that HB146 will create a liability-laden school environment. However, this argument assumes there is no liability exposure now---as if refusing to accommodate a student with diabetes is the low or no-cost option. This just isn't true • Many states have already passed similar legislation to HB146 and no post-enactment analyses have identified any increased liability exposure. On the contrary. When students with diabetes receive the care they need in school, the probability of adverse events is reduced, not increased.

6. HB146 will increase the school’s insurance premiums.
No. Caring for a child with diabetes at school comports no higher additional risk than caring for a child with asthma or severe allergies, two other chronic conditions of childhood that are more prevalent and convey higher probabilities of adverse events (anaphylaxis, cardiac arrest, etc.).

7.   Training staff will be expensive and difficult.  
No. The idea that implementing this bill will be expensive is, quite simply, a misconception borne out of fear • Training guidelines and online courses are readily available at no charge. Many local health departments can provide in-service training for free. Parents may be a good resource for staff training as they, with their children have regular check-ups that provide continuing education. Pediatric endocrinology nurses and Certified Diabetes Educators (CDE) are also excellent sources for staff training CONTACT LIST >>>

8.   HB146 will force me to do something I’m not trained to do.
No. You cannot be forced to serve as a care aide. If you volunteer to be a designated care aide, you will receive training.

9. “I’m a teacher, not a nurse. I don’t want to do this.”
Ok. It is the principal’s job to designate people who want to serve as care aides. And many will. In states that have passed legislation like HB146, it has been proven over and over again: many people want to volunteer and be trained in diabetes care and that the results---both for volunteers and students---are rewarding across a number of measures.

10. Diabetes care must be provided by a nurse.
No. The only time a person with Type 1 diabetes is routinely cared for by a nurse is in an acute care setting (i.e. in hospital at diagnosis). At all other times, diabetes is managed by lay people---parents, family, friends, teachers, administrators, coaches, bus drivers, even teenage babysitters---who receive some training, either formally or informally • A recent study published in Diabetes Care, shows that trained non-medical personnel can help children manage diabetes at school safely and effectively. The study analyzed the effects of legislation passed in 1999 that required Virginia schools to train at least two instructional, administrative or other employees on how to monitor blood glucose, administer insulin, treat hypoglycemia and what to do in an emergency.

11. Diabetes care is complicated and difficult to learn.
Yes and No. According to recent studies, most people in the U.S. don't know the difference between Type 1 and Type 2 diabetes, much less what a diabetes care regime consits of. Regrettably, rather than fill in this knowledge gap, some opposition interests seek to exploit it to cultivate fear and the idea that only licensed professionals are qualified to help students with diabetes care. • My 8-year-old daughter, diagnosed just one year ago, is capable of self-management. Many young children with diabetes are. She can test her blood, accurately draw insulin, inject herself, and count carbohydrates. She is always supervised in these activities, of course, but it underscores the point: If a child can learn to perform this care, surely administrators, teachers and nurses can learn, too.

12.   Insulin is a dangerous drug.
Yes. It can be dangerous. So can aspirin, Tylenol and Benedryl but that doesn’t prevent them from being used by children or from being sold over the counter like insulin.[1] The truth is all medications are dangerous because all medications hold the possibility of misuse.

13.   Insulin is a high-alert medication.
Yes. It’s one of the top three medications involved in medication errors in hospitals among patients 18 years of age and older. Most of these errors are errors of omission. That means something was left out or not done • A contributing factor to almost all of these errors is a lack of recent and relevant training in diabetes care across the strata of medical staff. Without training in the current standards of diabetes care and particularly the treatment differences between type 1 and type 2 diabetes, errors are made • For example, when hospital staff aren't familiar with the typical insulin intake for a 20 year-old type 1 diabetic---and a surprising number are not---an order for “4u” of insulin could be misread and result in a 40 unit dose instead of a 4 unit dose of insulin. A person with recent and relevant training, though, is more apt to recognize that a 40 unit dose of insulin is appropriate for counteracting insulin resistance—the hallmark of Type 2 diabetes. This is one reason why two hospital nurses are required to check orders and dose amounts prior to administration. It's done not just to verify the number of units drawn but to contextualize the dose.

14.   The Nursing Practice Act doesn't allow a nurse to accept orders from a parent and HB146 doesn’t have a provision for physician’s orders.
A mistake was made and corrected. Nurses must have a physician's order to administer prescription medication. A provision for physician's orders was in the original bill, dropped in Amendment 1 and reinstated in Amendment 3, the version that passed in the House.

15.   Non-licensed staff cannot be employed as care aides.
No. The Nursing Practice Act actually has a provision that allows for non-licensed people to provide care.[2] However, the recently renewed Nurse Practice Act includes new language that restricts delegation of administration of medication to licensed nurses only. This new provision effects a staffing mandate in schools that (1) already have a nurse and (2) utilize health care aides, who are no longer permitted to administer medication.

16.   HB146 forces school nurses to train care aides.
No. The Act says that a nurse may train an aide if he or she has recent, relevant training in the current standards of diabetes care.

17.   School nurses are responsible for the care aides.
No. The supervisory responsibility of the care aides lies with the principal.

18.   Nurses violate delegation regulations by training aides.
No. Title 68 is clear: "Delegation" means the transfer of responsibility for the performance of an activity or task from a registered professional nurse to an unlicensed or licensed person with the former retaining the accountability for the outcome. The responsibility for supervising care aides belongs to the principal, not the school nurse and without supervisory responsibility, it is impossible to violate Title 68 (Title 68: Professions And Occupations, Chapter Vii: Department of Financial And Professional Regulation Part 1300 Nursing And Advanced Practice Nursing Act - Registered Professional Nurse And Licensed Practical Nurse, Section 1300.10 Definitions).

19.   The Nursing Practice Act requires school nurses to be “certificated” if they are to train diabetes care aides.
No. In a school setting, nurses do not have to be certificated to train adults. Nurses must be “certificated” when their duties “require teaching or the exercise of instructional judgment or educational evaluation of pupils.”

20.   HB146 defines what a school nurse is differently than in the Illinois School Code. [4]
No. It’s just not the definition that the Illinois Association of School Nurses (IASN) would like. The IASN wants the definition of school nurse to use the word "certificated" because it effectively mandates an optional certification that is not required to be employed as a school nurse. Although a certificated school nurse must satisfy some number of continuing education HOURS, no CONTENT requirements are mandated, either in the care of diabetes or any other chronic illnesses. Thus, changing the definition of school nurse to include "certificated" adds little to no value to students with diabetes or other students with other chronic illnesses. [5] • Setting aside the value-added concerns for a moment, there is another aspect to defining what-is and what-is-not a school nurse: If only "certificated" nurses are permitted employment as school nurses, regular R.N.s would be forced to acquire certification or render non-compliant the schools they work for, a status that jeapordizes state and federal funding. In light of the nursing shortages throughout Illinois and the nation, restricting access in this fashion is a curious strategy for an association to persue.

21.   There have been attempts to pass legislation like this before and it failed. It was a bad idea then; it’s a bad idea now.
Yes and No. There have been two formal attempts to develop a uniform policy through legislation. The first was HB4150 filed in the 93rd General Assembly. In the end, that bill only satisfied a few special interest groups; it worked to obscure continuing failure (it created a policy to make a policy instead of creating a policy) but it did nothing specific for students with diabetes, which is why parents, advocates and the sponsors themselves abandoned it • It has yet proven possible to satisfy all interest groups and preserve the essential rights of the students with diabetes. Remaining opposition to this bill perceive it to be an infringement on professional prestige and job security, creating an odd and frankly unflattering juxtaposition of pitting grown-up interests against those of children with diabetes • As this debate wears on, it's important for legislators to recognize that the remaining questions and details of the debate lie on the margins, and while those corners are being dusted, and while we wait for leadership to emerge, students with diabetes continue to be forced out of classrooms, out of activities, and out of school. Now that's expensive.