By: Reyna, et al. (Senate Sponsor - Duncan) H.B. No. 984
(In the Senate - Received from the House May 11, 2005;
May 13, 2005, read first time and referred to Committee on Health
and Human Services; May 20, 2005, reported favorably, as amended,
by the following vote: Yeas 8, Nays 0; May 20, 2005, sent to
printer.)
COMMITTEE AMENDMENT NO. 1 By: Nelson
Amend C.S.H.B. 984 by striking proposed Section 168.009, Health an
Safety Code, on page 4, lines 28 through 34, and replacing with the
following:
Sec. 168.009. IMMUNITY FROM DISCIPLINARY ACTION OR
LIABILITY. (a) A school employee may not be subject to any
disciplinary proceeding, as defined by Section 22.0512(b),
Education Code, resulting from an action taken in compliance with
this subchapter. The requirements of this subchapter are
considered to involve the employee's judgment and discretion and
not considered ministerial acts for purposes of immunity from
liability under Section 22.0511, Education Code. Nothing in the
subchapter shall be considered to limit the immunity from liability
afforded under Section 22.0511, Education Code.
COMMITTEE AMENDMENT NO. 2 By: Nelson
Amend C.S.H.B. 984, on page 3, line 62, by striking "policy" and
replacing with "procedure".
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 168.005.
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 physician responsible for the student's
diabetes treatment.
(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 physician responsible for the student's diabetes treatment.
(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 physician responsible for the student's
diabetes treatment 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) At
each school in which a student with diabetes is enrolled, the school
principal shall:
(1) seek school employees who are not health care
professionals to serve as unlicensed diabetes care assistants and
care for students with diabetes; and
(2) make efforts to ensure that the school has:
(A) at least one unlicensed diabetes care
assistant if a full-time nurse is assigned to the school; and
(B) at least three unlicensed diabetes care
assistants if a full-time nurse is not assigned to the school.
(b) An unlicensed diabetes care assistant shall serve under
the supervision of the principal.
(c) A school employee may not be subject to any penalty or
disciplinary action for refusing to serve as an unlicensed diabetes
care assistant.
Sec. 168.005. TRAINING FOR UNLICENSED DIABETES CARE
ASSISTANT. (a) The Texas Diabetes Council shall develop
guidelines, with the assistance of the following entities, for the
training of unlicensed diabetes care assistants:
(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 the training of school employees acting as
unlicensed diabetes care assistants.
(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.
Sec. 168.006. 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. 168.007. REQUIRED CARE OF STUDENTS WITH DIABETES.
(a) If a school nurse is assigned to a campus and the nurse is
available, the nurse shall perform the tasks necessary to assist a
student with diabetes in accordance with the student's
individualized health plan. If a school nurse is not assigned to
the campus or a school nurse is not available, an unlicensed
diabetes care assistant shall perform the tasks necessary to assist
the student with diabetes in accordance with the student's
individualized health plan and in compliance with any guidelines
provided during training under Section 168.005. An unlicensed
diabetes care assistant may perform the tasks provided by this
subsection only if the parent or guardian of the student signs an
agreement that:
(1) authorizes an unlicensed diabetes care assistant
to assist the student; and
(2) states that the parent or guardian understands
that an unlicensed diabetes care assistant is not liable for civil
damages as provided by Section 168.009.
(b) 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 the physician
responsible for the student's diabetes treatment.
(c) Each school shall adopt a policy to 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.
(d) 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.
(e) An unlicensed diabetes care assistant who assists a
student as provided 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.
(f) An unlicensed diabetes care assistant may exercise
reasonable judgment in deciding whether to contact a health care
provider in the event of a medical emergency involving a student
with diabetes.
Sec. 168.008. INDEPENDENT MONITORING AND TREATMENT. In
accordance with the student's individualized health plan, a school
shall permit the student to attend to the management and care of the
student's diabetes, which may include:
(1) performing blood glucose level checks;
(2) administering insulin through the insulin
delivery system the student uses;
(3) treating hypoglycemia and hyperglycemia;
(4) possessing 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 attending 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.
Sec. 168.009. IMMUNITY FROM DISCIPLINARY ACTION OR
LIABILITY. (a) A school employee may not be subject to any
disciplinary action and is immune from liability for civil damages
resulting from an action taken in compliance with this subchapter
if the employee acted in the same manner as an ordinarily reasonable
and prudent person would have acted under the same or similar
circumstances.
(b) A school nurse is not responsible for and may not be
subject to disciplinary action under Chapter 301, Occupations Code,
for actions performed by an unlicensed diabetes care assistant.
SECTION 2. Chapter 168, Health and Safety Code, as added by
this Act, 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.
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