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79R3937 SLO-D
By: Reyna H.B. No. 984
A BILL TO BE ENTITLED
AN ACT
relating to the care of elementary and secondary school students
with diabetes.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle H, Title 2, Health and Safety Code, is
amended by adding Chapter 168 to read as follows:
CHAPTER 168. CARE OF STUDENTS WITH DIABETES
Sec. 168.001. DEFINITIONS. In this chapter:
(1) "Diabetes management and treatment plan" means the
document required by Section 168.002.
(2) "Individualized health plan" means the document
required by Section 168.003.
(3) "Principal" includes the principal's designee.
(4) "School" means a public elementary or secondary
school. The term does not include an open-enrollment charter
school established under Subchapter D, Chapter 12, Education Code.
(5) "School employee" means a person employed by:
(A) a school;
(B) a local health department that assists a
school under this chapter; or
(C) another entity with which a school has
contracted to perform its duties under this chapter.
(6) "Unlicensed diabetes care assistant" means a
school employee who has successfully completed the training
required by Section 168.004.
Sec. 168.002. DIABETES MANAGEMENT AND TREATMENT PLAN. (a)
A diabetes management and treatment plan must be developed and
implemented for each student with diabetes who will seek care for
the student's diabetes while at school or while participating in a
school activity. The plan shall be developed by:
(1) the student's parent or guardian; and
(2) the student's personal health care team.
(b) A diabetes management and treatment plan must:
(1) identify the health care services the student may
receive at school;
(2) evaluate the student's ability to manage and level
of understanding of the student's diabetes; and
(3) be signed by the student's parent or guardian and
the student's personal health care team.
(c) The parent or guardian of a student with diabetes who
seeks care for the student's diabetes while the student is at school
shall submit to the school a copy of the student's diabetes
management and treatment plan. The plan must be submitted to and
reviewed by the school:
(1) before or at the beginning of the school year;
(2) on enrollment of the student, if the student
enrolls in the school after the beginning of the school year; or
(3) as soon as practicable following a diagnosis of
diabetes for the student.
Sec. 168.003. INDIVIDUALIZED HEALTH PLAN. (a) An
individualized health plan is a coordinated plan of care designed
to meet the unique health care needs of a student with diabetes in
the school setting.
(b) An individualized health plan must be developed for each
student with diabetes who will seek care for diabetes while at
school or while participating in a school activity. The school
principal and the school nurse, if a school nurse is assigned to the
school, shall develop a student's individualized health plan in
collaboration with the student's parent or guardian and, to the
extent practicable, the student's personal health care team and one
or more of the student's teachers.
(c) A student's individualized health plan must incorporate
components of the student's diabetes management and treatment plan,
including the information required under Section 168.002(b). A
school shall develop a student's individualized health plan on
receiving the student's diabetes management and treatment plan.
Sec. 168.004. UNLICENSED DIABETES CARE ASSISTANT. (a) The
Texas Diabetes Council shall develop guidelines, with the
assistance of the following entities, for the training of school
employees who are not health care professionals to become
unlicensed diabetes care assistants and care for students with
diabetes:
(1) the department's School Health Program;
(2) the American Diabetes Association;
(3) the Juvenile Diabetes Research Foundation
International;
(4) the American Association of Diabetes Educators;
(5) the Texas Nurses Association;
(6) the Texas School Nurse Organization; and
(7) the Texas Education Agency.
(b) If a school nurse is assigned to a campus, the school
nurse shall coordinate training and supervising school employees
acting as unlicensed diabetes care assistants. If a school nurse is
not assigned to a campus:
(1) an unlicensed diabetes care assistant must have
access to an individual with expertise in the care of persons with
diabetes, such as a physician, a registered nurse, a certified
diabetes educator, or a licensed dietitian; or
(2) the principal must have access to a licensed
health care professional who is a member of the student's personal
health team.
(c) Training under this section must be provided by a health
care professional with expertise in the care of persons with
diabetes or by the school nurse. The training must be provided
before the beginning of the school year or as soon as practicable
following:
(1) the enrollment of a student with diabetes at a
campus that previously had no students with diabetes; or
(2) a diagnosis of diabetes for a student at a campus
that previously had no students with diabetes.
(d) The training must include instruction in:
(1) recognizing the symptoms of hypoglycemia and
hyperglycemia;
(2) understanding the proper action to take if the
blood glucose levels of a student with diabetes are outside the
target ranges indicated by the student's diabetes management and
treatment plan;
(3) understanding the details of a student's
individualized health plan;
(4) performing finger-sticks to check blood glucose
levels, checking urine ketone levels, and recording the results of
those checks;
(5) properly administering glucagon and insulin and
recording the results of the administration;
(6) recognizing complications that require seeking
emergency assistance; and
(7) understanding the recommended schedules and food
intake for meals and snacks for a student with diabetes, the effect
of physical activity on blood glucose levels, and the proper
actions to be taken if a student's schedule is disrupted.
(e) The school nurse or principal shall maintain a copy of
the training guidelines and any records associated with the
training.
(f) The board of trustees of a school district shall ensure
that there are at least three unlicensed diabetes care assistants
at each campus attended by one or more students with diabetes.
Sec. 168.005. REQUIRED INFORMATION FOR CERTAIN EMPLOYEES.
A school district shall provide to each district employee who is
responsible for providing transportation for a student with
diabetes or supervising a student with diabetes during an
off-campus activity a one-page information sheet that:
(1) identifies the student who has diabetes;
(2) identifies potential emergencies that may occur as
a result of the student's diabetes and the appropriate responses to
such emergencies; and
(3) provides the telephone number of a contact person
in case of an emergency involving the student with diabetes.
Sec. 168.006. REQUIRED CARE OF STUDENTS WITH DIABETES. (a)
At the request of a parent or guardian of a student with diabetes
and in compliance with the student's individualized health plan, an
unlicensed diabetes care assistant shall:
(1) take the proper action to treat the student's
symptoms of hypoglycemia and hyperglycemia;
(2) respond to the student's blood glucose level if it
is outside the target range specified in the diabetes management
and treatment plan;
(3) administer glucagon to the student;
(4) administer insulin to the student or assist the
student in administering insulin through an insulin delivery system
that the student uses;
(5) administer oral diabetes medication to the
student;
(6) check and record the student's blood glucose
levels and urine ketone levels or assist the student with checking
and recording those levels; and
(7) assist the student in following instructions
regarding meals, snacks, and physical activity.
(b) A school shall ensure that a school nurse or at least one
unlicensed diabetes care assistant is present and available to
provide the required care to a student with diabetes during the
regular school day.
(c) A school district may not restrict the assignment of a
student with diabetes to a particular campus on the basis that the
campus does not have the required unlicensed diabetes care
assistants.
(d) An unlicensed diabetes care assistant who performs an
activity described by Subsection (a) in compliance with a student's
individualized health plan:
(1) is not considered to be engaging in the practice of
professional or vocational nursing under Chapter 301, Occupations
Code, or other state law; and
(2) is exempt from any applicable state law or rule
that restricts the activities that may be performed by a person who
is not a health care professional.
Sec. 168.007. INDEPENDENT MONITORING AND TREATMENT. On the
written request of a parent or guardian of a student with diabetes,
and in accordance with the student's diabetes management and
treatment plan, a school shall permit the student to:
(1) perform blood glucose level checks;
(2) administer insulin through the insulin delivery
system the student uses;
(3) treat hypoglycemia and hyperglycemia;
(4) possess on the student's person at any time any
supplies or equipment necessary to monitor and care for the
student's diabetes; and
(5) otherwise attend to the management and care of the
student's diabetes in the classroom, in any area of the school or
school grounds, or at any school-related activity.
SECTION 2. Chapter 168, Health and Safety Code, applies
beginning with the 2005-2006 school year.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2005.