Dear Senate Appropriations Committee Member,
I urge your NO vote on SB 1051 re: Diastat rectal gel administration by unlicensed personnel in our schools,grades K-12. Please consider the “elephant in the room” before you vote on this bill:
Who does this bill really benefit? Is it  really the epileptic patient? (Or is it the School Districts, who seek to relieve themselves of legal liability? And the pharmaceutical company which gets to market more and more of the drug, as it expires every few months?)
The Epilepsy Foundation website recommends doing NOTHING to treat a seizure, save turning the patient to the side and placing something under his head,  and perhaps calling 911, as needed,  as most last only a few minutes.
And where will Diastat  (a type 2 controlled drug which has value on the black market, of course), be secured in the meantime? In a pocket? A drawer? The office? Under lock and key? How long would it take to fetch it?
Diastat directions state it needs to be given within 2-5 minutes of the seizure onset.
After it is found, how long will it take to:
-unhinge the Diastat from it’s double-locks?
(-put on gloves?)
-run to the pt
-pull down the pants of that writhing person, and
-insert it properly
??
Monitoring the pt for up to four hours is also in the directive, on the Diastat website, which also mentions the side effects and dangers of giving it to a pt who is not having a breakthrough seizure. This drug will  rapidly cause the person to experience to sleep. Deep sleep.
If the student is having a life-threatening seizure, certainly medical assistance is needed; this drug might help, but someone will still have to carry the patient to a place to recover (and where would that be in the school?)
According to the Diastat website, the drug can also be abused. It is not to be used more than once every 4-5 days. In an emergency, who at the school is aware of the frequency of administration at home or other places?
What price, in terms of psychological harm, will the patient pay for having a thing rudely inserted up the derriere in the middle of the classroom or playground? Isn’t it bad enough that the patient will have soiled himself?
And what if the non-medical personnel, in a hurry and unused to such rectal administration, makes a mistake and inserts it in the female vagina? Read the circular about that result.
The two sides of this bill both argue they care very much about the children.
I realize there is a mighty powerful lobby in support, but I ask you to consider this quote from the American Academy of Pediatrics:
The presence in schools of a full-time licensed registered school nurse is strongly endorsed.13 Registered nurses (RNs) have the knowledge and skills required for the delivery of medication, the clinical knowledge of the student’s health, and the responsibility to protect the health and safety of all students. The use of untrained school staff to administer medications to children with special health care needs creates risks, not only of medical liability for the school and the licensed registered school nurse but also of medication error for the student.14–16 To ensure the health and safety of students, all schools should have a full-time licensed RN who has the knowledge and skills required for the delivery of medication and the assessment of student health.17,18

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;124/4/1244

Thank you for your NO vote on SB 1051. There is a better solution: AB 2454.
Respectfully,
Candace Campbell,  MSN-HCSM, RN
Film maker, Author, Nurse educator
925.207.1376
Peripatetic Productions, LLC
Host of The Preemie Post blog & podcasts
www.candycampbell.com
www.CandytheNurse.com

This month let me tell you about a movement in California that has generated great concern among many of us moms who are also nurses. You are aware that the decisions of one state often lead to the next legislation for the other forty-nine. Parents of preemies, listen up, as your child may be involved in one of these scenarios.

There are presently two bills pending before our legislature which intend to protect the school districts from lawsuits brought by parents who react to faulty administration of medications to their children. These bills, AB 1802 (re: Insulin) and SB 1051 (re:Diastat rectal gel) are both worrisome. Why? Each has the possibility of physical and/ or psychological  harm to  the student if—

• given the wrong dose,
• given wrong site,
  

  Insulin

• given incorrectly,
• or given at all.

But what’s a mother to do? If the type 1 diabetic child becomes hypo- or hyper-glycemic (Hmmm, now which is which?) and requires Insulin, as opposed to Glucagon, and a nurse isn’t around…?

And what’s a mother to do if her child, K-12, suffers a (what is commonly called)  grand mal seizure in class or on the field? Does it make sense for the first responder to pull down the pants of that linebacker, unlock the Valium Rectal gel from wherever they decide it must be sequestered, and jam the syringe inside the poor student’s you-know-where, within the first 5 minutes, otherwise it is not effective?

And why has the  Epilieptic Foundation joined with the drug manufacturer to nod to this practice,when on their own website they advise first responders to do nothing but turn the victim to the side, and make him comfortable by placing a pillow or something soft beneath the head ? There may be exceptions, they say, but circumstances requiring medical intervention should be planned. Instead of calling 911, this is the plan? (http://www.epilepsyfoundation.org/about/quickstart/parents/qsprmanaging.cfm)

Diastat rectal syringe

Valium is a controlled substance, BTW, and in demand by certain folks who, shall we say, would want to take it without purchasing?

Lucky for us, the school districts (and the American Diabetic Assoc., plus the AMA; the  Epileptic Foundation, and the drug manufacturer) have the answer. They propose a volunteer (i.e., an unlicensed medical person), and a parent make a contract, in which the parent gives up the right to sue in case of dire consequences,or negligence, based on the volunteer’s lack of knowledge. Clever!

This is tantamount to hiring a handyman instead of a licensed electrician to wire your house. It may be a “cheap” fix, but there will be hell to pay if something goes wrong. Not to mention… it’s illegal! Yes, the Nurse Practice Act, which mandates the education and licensing of nurses, was established for the public good, just like the Building and Safety Code. Both protect consumers. From what? From deadly mistakes.

Their solution is just (may I say it?) a bandaid on the problem.

We know each school district gets a budget allocation from the state. We know budgets have been cut for “nonessentials” like music, art, P.E., and school nurses. And what are the consequences ? Sicker students have more need for knowledgeable nursing intervention at school.

Hurray for California Assemblymember Tom Torlakson, who served many  years as a teacher in California public schools. He has offered AB 2454, which mandates a safe-staffing ratio for school nurses.  If you like, here’s a homework assignment for you parents. What is  the ratio of students per  licensed nurse in your school district? Each is different, but I guarantee the answer will frighten you.

I apologize for  tardy posts. The trail has taken me again to the halls of legislature to learn and participate in healthcare debates which influence families, babies, and of course, nurses. I am completing a residency with the nurse advocates who work with the American Nurses’ Association in Sacramento, CA.

Sacramento Capitol

It was sloppy-wet day, but always a thrill to walk the hallowed halls of the capitol. I will finish the week here and return often until my work is completed, at the end of April.

At the Assembly Health Committee forum, I watched the fascinating grilling of Big Business (insurance companies in the arena today) for over two hours. This is Theatre of the Real, people! I believe you would be proud of most of your elected representatives who spoke,some eloquently, some pointedly and some in a genteel manner. Others were not so nice. (Recall visions of “Inherit The Wind.”)

Those who represented (one of the largest of the large) insurance companies gave cogent summations of their responsibilities and offered “the softer side” of what many consumers consider  cut-throat profiteering practices. Try as they might to cast aside aspersions with melodious, well-chosen arguments, the gallery was wriggling in their seats. One legislator summed it up by saying that it’s not business, per se, which is the concern here, it is the monopoly-factor which with health insurance corporations stifle real competition in the marketplace, and cry “ouch” as they calmly explain why they need to raise costs up to 36% in a month from now?!

A few citizens put a face to the dilemma during the public forum. One, a retired MD, sees from both sides now. He characterizes the irony: insurance companies regularly  lower physician reimbursements, while complaining to customers that because of demanding healthcare practitioners, it is necessary to raise rates…all the while fat-cat execs take (“earn” would be a misnomer) as much as $24 million a year!

Stay tuned for more … the debate surrounding premature babies and healthcare benefits has only just begun.

Candy