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AMENDED
May 16, 2001
H. 3968
Introduced by Reps. J. Brown, Townsend, W.D. Smith, Sandifer, McGee, Robinson, Barrett, Hayes, Simrill, Gourdine, Scott, Cotty, J.E. Smith, Cato, Whipper, Tripp, Coates, Kennedy, Allison, J.H. Neal, Howard, Hosey, Knotts, G.M. Smith, McCraw, Law, Koon, Whatley, Cooper, Bales, Leach, Allen, Altman, Barfield, Battle, Bingham, Bowers, Breeland, R. Brown, Campsen, Chellis, Clyburn, Coleman, Dantzler, Davenport, Delleney, Edge, Emory, Freeman, Frye, Gilham, Govan, Hamilton, Harrell, Harrison, Harvin, J. Hines, M. Hines, Huggins, Kelley, Kirsh, Klauber, Lee, Limehouse, Littlejohn, Lloyd, Lourie, Mack, Martin, McLeod, Meacham-Richardson, Merrill, Miller, Moody-Lawrence, J.M. Neal, Ott, Owens, Parks, Perry, Phillips, Quinn, Riser, Rivers, Rodgers, Rutherford, Scarborough, Sinclair, F.N. Smith, Snow, Stille, Taylor, Vaughn, Walker, Webb, White, Wilder, Witherspoon and A. Young
S. Printed 5/16/01--H.
Read the first time April 19, 2001.
EXPLANATION OF IMPACT:
State Department of Education (SDE)
Enactment of this bill would have no direct impact on the General Fund of the State nor on federal and/or other funds, since the bill places requirements for implementation on the local school districts. Any potential impact on the General Fund of the State is discretionary on the part of the General Assembly, which may choose to appropriate funds for costs incurred by the local school districts (see Special Notes below).
Department of Health and Environmental Control (DHEC)
The bill requires DHEC to provide private schools with copies of this legislation and "diabetes care provider" training materials previously developed for school districts. DHEC indicates that printing and distribution costs would be minimal, and can be absorbed within the agency's current operating budget.
LOCAL GOVERNMENT IMPACT:
See Special Notes below.
SPECIAL NOTES:
Section 44-39-220 (B) & (C) requires school districts to provide training for diabetes care providers and bus drivers. It is assumed the districts would contract with a private entity for this training. Total cost to the training entity is estimated at approximately $200,000 annually, which includes compensation for four employees. Therefore, if the districts were charged the actual cost of training, the total aggregate impact on the districts can be estimated at $200,000. In addition, since bus drivers are paid on an hourly rate, the cost to provide compensation for one day's training would be approximately $231,000 (5,500 bus drivers x 6 hours x $7 an hour). Substitute teachers may also be needed while training is provided to full-time teachers (who may be designated diabetes care providers). The cost per substitute teacher is $40 per day.
SDE indicates enactment of this bill may cause school districts to hire a full time nurse in schools where a nurse is not currently on staff since section 44-39-210 states that a school nurse is preferred as a diabetes care provider. There are 520 schools that currently do not employ a nurse. A nurse's annual salary and fringe is approximately $40,000.
Approved By:
Don Addy
Office of State Budget
TO AMEND CHAPTER 39, TITLE 44, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO THE "DIABETES INITIATIVE OF SOUTH CAROLINA ACT", BY ADDING ARTICLE 2, SO AS TO ENACT THE "DIABETES SCHOOL CARE ACT", TO REQUIRE THE PRINCIPAL AT EACH PUBLIC SCHOOL TO DESIGNATE THREE EMPLOYEES TO BE DIABETES CARE PROVIDERS, TO ALSO AUTHORIZE AS EMPLOYEES OF THE DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL ASSIGNED TO A SCHOOL AND SUBCONTRACTORS TO BE DIABETES CARE PROVIDERS, TO PROVIDE FOR THE TRAINING OF THESE CARE PROVIDERS, TO ESTABLISH THE RESPONSIBILITIES AND THE SCOPE OF AUTHORITY FOR A DIABETES CARE PROVIDER, TO ALLOW A STUDENT WITH DIABETES TO PERFORM GLUCOSE TESTS, ADMINISTER INSULIN, AND TO ATTEND TO THE CARE AND MANAGEMENT OF HIS OR HER DIABETES AND TO POSSES NECESSARY SUPPLIES AND EQUIPMENT TO CONDUCT THESE FUNCTIONS, TO REQUIRE THE DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL TO MAKE INFORMATION AND TRAINING MATERIALS AVAILABLE TO PRIVATE SCHOOLS, AND TO PROVIDE THAT A DIABETES CARE PROVIDER ACTING IN ACCORDANCE WITH THIS ARTICLE IS IMMUNE FROM CIVIL AND CRIMINAL LIABILITY AND IS NOT PRACTICING NURSING AND IS EXEMPT FROM ALL APPLICABLE STATUTORY AND REGULATORY PROVISIONS THAT RESTRICT WHAT ACTIVITIES MAY BE DELEGATED TO A PERSON WHO IS NOT A LICENSED MEDICAL PROFESSIONAL; AND TO DESIGNATE SECTIONS 44-39-10 THROUGH 44-39-50 AS ARTICLE 1, CHAPTER 39, TITLE 44 ENTITLED "DIABETES INITIATIVE OF SOUTH CAROLINA" AND TO RENAME CHAPTER 39, TITLE 44 AS "DIABETES".
Amend Title To Conform
Whereas, diabetes is a serious, chronic disease that impairs the body's ability to use food. Diabetes must be managed twenty-four hours a day in order to avoid the potentially life-threatening, short-term consequences of blood sugar levels that are either too high or too low, and to avoid or delay the serious long-term complications of high blood sugar levels which include blindness, amputation, heart disease, and kidney failure. In order to manage their disease, students with diabetes must have access to the means to balance food, medications, and activity level while at school and at school-related activities; and
Whereas, because of the significant number of students with diabetes, the effect of diabetes upon a student's ability to learn, and the risk for serious long and short-term medical complications, the South Carolina General Assembly finds that it is in the best interest of South Carolina's children with diabetes to enact the "Diabetes School Care Act." Now, therefore,
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Chapter 39 of Title 44 is amended by adding:
Section 44-39-200. This article may be cited as the 'Diabetes Mellitus School Care Act'.
Section 44-39-210. For purposes of this article:
(1) 'Diabetes care provider' means a school employee trained in accordance with Section 44-39-220. While a school nurse is a preferred diabetes care provider, a diabetes care provider is not required to be a medical professional. When a school nurse is assigned to a particular school, he or she shall coordinate the provision of diabetes care at that school.
(2) 'School' means a primary, elementary, middle, or secondary public school located within this State.
(3) 'School employee' means a person employed by a public school district or a public special school or a person employed by a local health department who is assigned to a public school or a subcontractor designated for this function.
Section 44-39-220. (A) The Diabetes Initiative of South Carolina, working in cooperation with the South Carolina Board of Nursing, South Carolina Department of Health and Environmental Control, South Carolina Department of Education, and the South Carolina Office of the American Diabetes Association shall develop guidelines for the training of school employees as diabetes care providers. Training must be provided annually by a health care professional with expertise in diabetes and training guidelines must include instruction in:
(1) recognition and treatment of hypoglycemia and hyperglycemia;
(2) understanding the appropriate actions to take when blood glucose levels are outside of the target ranges indicated by student's physician's order or health care plan, or both;
(3) understanding physician instructions concerning drug dosage, frequency, and the manner of administration;
(4) performance of finger-stick blood glucose testing, ketone testing, and recording the results;
(5) administration of oral medications, glucagon, and insulin and the recording of results;
(6) recommended schedules and food intake for meals and snacks, the effect of exercise upon blood glucose levels, and actions to be implemented in the case of schedule disruption.
(B) Each public school district shall provide or contract for the training provided for in subsection (A) to at least one school employee who must be designated as a diabetes care provider by the principal at each public school that does not employ a full-time registered nurse.
(C) Each public school shall develop a written protocol with procedures to be followed if a student diabetes emergency arises when neither a registered nurse nor a diabetes care provider is available.
Section 44-39-230. (A) In accordance with the written instructions of the physician of a student with diabetes, diabetes care providers shall perform functions including, but not limited to:
(1) administering glucagon in an emergency situation;
(2) assisting a student in administering insulin through the insulin delivery system the student uses;
(3) assisting a student in administering other oral diabetes medications;
(4) assisting a student in performing and recording blood glucose testing and ketone testing or assisting a student with such testing; and
(5) following instruction regarding meals, snacks, and physical education.
However, a diabetes care provider may only perform such functions if the student's parent or guardian has informed the school that the student has diabetes mellitus.
(B) A diabetes care provider must be on site and available to assist or to provide care to students with diabetes as set forth in subsection (A) during regular school hours.
(C)(1) A diabetes care provider is immune from civil and criminal liability if the care provider is acting within the scope of his authority as prescribed in this article and in accordance with the training standards and procedures as provided for in Section 44-39-220.
(2) Notwithstanding any other provision of law, a diabetes care provider trained pursuant to Section 44-39-220 who is carrying out the functions enumerated in subsection (A) is not engaging in the practice of nursing and is exempt from all applicable statutory and regulatory provisions that restrict activities that may be delegated to a person who is not a licensed medical professional.
Section 44-39-240. (A) Upon written request of the parent or guardian and authorization by the student's physician, a student with diabetes must be permitted to perform blood glucose tests, administer insulin through the insulin delivery system the student uses, treat hypoglycemia and hyperglycemia, and otherwise attend to the care and management of his or her diabetes in the classroom, in any area of the school or school grounds, and at any school-related activity and to possess on his or her person at all times all necessary supplies and equipment to perform these monitoring and treatment functions.
(B) A student's school choice shall in no way be restricted because the student has diabetes.
(C) a student with diabetes may not be denied access or prohibited from participating in school activities and programs including, but not limited to, school-sponsored before-school programs, after school care programs, field trips, and extracurricular activities.
(D) Each public school district shall develop a policy to implement the provisions of this article.
Section 44-39-250. (A) The South Carolina Department of Health and Environmental Control shall provide each private school in the State with a copy of this article and shall make the training materials developed in accordance with Section 44-39-220 available to private schools.
(B)(1) A diabetes care provider employed by a private school or a subcontractor designated for this function is immune from civil and criminal liability if the care provider is acting within the scope of his authority as prescribed in this article and in accordance with the training standards and procedures as provided for in Section 44-39-220.
(2) Notwithstanding any other provision of law, a diabetes care provider who received training comparable to the training provided for in Section 44-39-220 who is carrying out the functions enumerated in Section 44-39-230(A) is not engaging in the practice of nursing and is exempt from all applicable statutory and regulatory provisions that restrict activities that may be delegated to a person who is not a licensed medical professional."
Section 44-39-260. All costs associated with implementing the provisions contained in this article must be borne by the State through an annual appropriation from the state general fund or through private funding. To the extent that a school district incurs any expenses that are not paid for by the State, the provisions in this article that apply to that school district are suspended.
SECTION 2. Sections 44-39-10 through 44-39-50 of the 1976 Code are designated as Article 1, Chapter 39, Title 44 entitled "Diabetes Initiative of South Carolina" Chapter 39, Title 44 of the 1976 Code is renamed "Diabetes".
SECTION 3. Notwithstanding the provisions of Section 44-39-220 of the 1976 Code as added by Section 1 of this act, the training required to be provided pursuant to that section for school employees is not required to be implemented until one year after this act's effective date.
SECTION 4. This act takes effect upon approval by the Governor.
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