| 1 | 1 | | General Assembly Raised Bill No. 1178 |
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| 2 | 2 | | January Session, 2011 LCO No. 4258 |
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| 3 | 3 | | *04258_______PH_* |
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| 4 | 4 | | Referred to Committee on Public Health |
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| 5 | 5 | | Introduced by: |
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| 6 | 6 | | (PH) |
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| 7 | 7 | | |
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| 8 | 8 | | General Assembly |
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| 9 | 9 | | |
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| 10 | 10 | | Raised Bill No. 1178 |
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| 11 | 11 | | |
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| 12 | 12 | | January Session, 2011 |
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| 13 | 13 | | |
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| 14 | 14 | | LCO No. 4258 |
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| 15 | 15 | | |
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| 16 | 16 | | *04258_______PH_* |
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| 17 | 17 | | |
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| 18 | 18 | | Referred to Committee on Public Health |
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| 19 | 19 | | |
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| 20 | 20 | | Introduced by: |
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| 21 | 21 | | |
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| 22 | 22 | | (PH) |
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| 23 | 23 | | |
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| 24 | 24 | | AN ACT CONCERNING THE CARE AND TREATMENT OF STUDENTS WITH DIABETES WHILE AT SCHOOL. |
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| 25 | 25 | | |
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| 26 | 26 | | Be it enacted by the Senate and House of Representatives in General Assembly convened: |
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| 27 | 27 | | |
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| 28 | 28 | | Section 1. (NEW) (Effective July 1, 2011) As used in sections 1 to 4, inclusive, of this act and section 10-212a of the general statutes, as amended by this act: |
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| 29 | 29 | | |
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| 30 | 30 | | (1) "School-designated care aide" means a school employee who has: (A) Agreed to receive training in diabetes care to assist students in implementing a diabetes care plan; and (B) entered into a written agreement with the parent or guardian of a student with diabetes and the school to provide diabetes care services. |
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| 31 | 31 | | |
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| 32 | 32 | | (2) "Diabetes care plan" means a written document prepared by a health care provider that identifies the diabetes-related services needed by a student while at school and at school-sponsored activities. |
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| 33 | 33 | | |
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| 34 | 34 | | (3) "Health care provider" means a physician licensed pursuant to chapter 370 of the general statutes, a physician assistant licensed under chapter 370 of the general statutes or an advanced practice registered nurse licensed under chapter 378 of the general statutes. |
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| 35 | 35 | | |
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| 36 | 36 | | (4) "School" means a public school, as defined in section 10-183b of the general statutes, or a nonpublic elementary or secondary school, attendance at which meets the requirements of section 10-184 of the general statutes. |
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| 37 | 37 | | |
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| 38 | 38 | | (5) "School employee" means a person employed by a school or under contract with a school who performs services in connection with a student's diabetes care plan. |
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| 39 | 39 | | |
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| 40 | 40 | | Sec. 2. (NEW) (Effective July 1, 2011) (a) The parent or guardian of any student who has received a diabetes care plan from a health care provider shall be responsible for supplying such plan to the student's school. A diabetes care plan shall be signed by the student's parent or guardian. In the event that a school maintains an individualized education plan or a plan under Section 504 of the Rehabilitation Act of 1973 for a student with a diabetes care plan, the diabetes care plan shall be included as a component part of such other plan. A diabetes care plan shall include: (1) A health care provider's instructions concerning the student's diabetes management while at school and school-sponsored activities, (2) copies of any prescriptions relating to the student's diabetes management and instructions concerning the administration of prescribed drugs, and (3) instructions on any insulin administration required by the student. |
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| 41 | 41 | | |
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| 42 | 42 | | (b) The services and accommodations, if any, contained in a diabetes care plan shall be reasonable, reflect current standards of diabetes care, include appropriate safeguards to ensure that syringes and lancets are disposed of properly, include requirements for daily diet, glucose testing and insulin administration and address treatment of hypoglycemia, hyperglycemia and emergency situations. |
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| 43 | 43 | | |
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| 44 | 44 | | (c) When presented with a diabetes care plan, a school principal or school nurse shall confer with the parent or guardian of the student who is the subject of the plan and any school-designated care aide concerning the plan's implementation. A diabetes care plan shall specify the procedures contained in the plan that may be delegated to a school-designated care aide. When implementing a diabetes care plan, a school shall be responsible for maintaining a complete written record relating to the implementation of the plan. The record shall include the results of any glucometer readings taken during the school day by a school nurse or school-designated care aide, as well as a record of any insulin administered during the school day by a school nurse or school-designated care aide. The plan shall also include provisions that address required communication between school personnel and the parent or guardian of a student, or the student's health care provider concerning any issues that may affect implementation of the plan. |
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| 45 | 45 | | |
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| 46 | 46 | | (d) A parent or guardian of a student who is the subject of a diabetes care plan shall be responsible for providing the school with a copy of any modification of the plan. Any such plan modification presented to the school shall be prepared by a health care provider, and signed by the student's parent or guardian and health care provider. |
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| 47 | 47 | | |
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| 48 | 48 | | Sec. 3. (NEW) (Effective July 1, 2011) A school-designated care aide may perform any of the duties necessary to implement a student's diabetes care plan. In the event that a student's consumption of an unexpected snack or meal while at school requires a school-designated care aide to administer a dose of insulin not contemplated in the student's diabetes care plan, to the extent practicable, prior to administering the insulin, the school-designated care aide shall consult with the student's parent or guardian, health care provider or school nurse to confirm that the insulin dose to be administered is appropriate given the number of carbohydrates ingested and the student's blood glucose level as determined by a glucometer reading. A school-designated care aide shall carry out all assigned duties in accordance with the training described in section 4 of this act. |
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| 49 | 49 | | |
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| 50 | 50 | | Sec. 4. (NEW) (Effective July 1, 2011) (a) Not later than January 1, 2012, the Department of Education, in conjunction with the Department of Public Health, shall develop and make available to each local and regional board of education guidelines for the management of students with diabetes. The guidelines shall include, but need not be limited to: (1) Education and training for school personnel on the management of students with diabetes, including training related to the permissible duties of school-designated care aides pursuant to subsection (d) of section 10-212a of the general statutes, as amended by this act, (2) procedures for identifying when a student with diabetes needs immediate or emergency medical care, and (3) protocols for notification of a student's parent, guardian or health care provider in the event of an emergency situation. |
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| 51 | 51 | | |
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| 52 | 52 | | (b) Not later than July 1, 2012, each local and regional board of education shall: (1) Implement a plan based on the guidelines developed pursuant to subsection (a) of this section for the management of students with diabetes enrolled in the schools under its jurisdiction; (2) make such plan available on such board's web site or the web site of each school under such board's jurisdiction, or if such web sites do not exist, make such plan publicly available through other practicable means as determined by such board; and (3) provide notice of such plan in conjunction with the annual written statement provided to parents and guardians as required by subsection (b) of section 10-231c of the general statutes. The superintendent of schools for each school district shall annually attest to the Department of Education that such school district is implementing such plan in accordance with the provisions of this section. |
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| 53 | 53 | | |
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| 54 | 54 | | (c) Not later than July 1, 2012, each local and regional board of education shall have developed and implemented a program to provide required training for any person who wishes to serve as a school-designated care aide. Such training shall address issues that include, but are not limited to: (1) Checking blood glucose and recording the results of such checks, (2) recognizing and responding to the symptoms of hypoglycemia, (3) recognizing and responding to the symptoms of hyperglycemia, (4) estimating the number of snack or carbohydrates in snacks or meals, (5) administering insulin and recording insulin administrations, (6) emergency response protocols, and (7) the role of the school-designated care aide when implementing a diabetes care plan and maintaining records relating to the implementation of such plan. |
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| 55 | 55 | | |
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| 56 | 56 | | (d) Training provided pursuant to this section shall be consistent with any guidelines published by the United States Department of Health and Human Services. To the extent feasible, training shall be provided by health care providers with expertise in the care and treatment of diabetes, including, but not limited to, school nurses possessing such expertise. |
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| 57 | 57 | | |
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| 58 | 58 | | Sec. 5. Subsections (c) and (d) of section 10-212a of the general statutes are repealed and the following is substituted in lieu thereof (Effective July 1, 2011): |
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| 59 | 59 | | |
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| 60 | 60 | | (c) The State Board of Education, in consultation with the Commissioner of Public Health, shall adopt regulations, in accordance with the provisions of chapter 54, determined to be necessary by the board to carry out the provisions of this section, including, but not limited to, regulations that (1) specify conditions under which a coach of intramural and interscholastic athletics may administer medicinal preparations, including controlled drugs specified in the regulations adopted by the commissioner, to a child participating in such intramural and interscholastic athletics, (2) specify conditions and procedures for the administration of medication by school personnel to students, and (3) specify conditions for self-administration of medication by students, including permitting a child diagnosed with: (A) Asthma to retain possession of an asthmatic inhaler at all times while attending school for prompt treatment of the child's asthma and to protect the child against serious harm or death provided a written authorization for self-administration of medication signed by the child's parent or guardian and an authorized prescriber is submitted to the school nurse; [and] (B) an allergic condition to retain possession of an automatic prefilled cartridge injector or similar automatic injectable equipment at all times while attending school for prompt treatment of the child's allergic condition and to protect the child against serious harm or death provided a written authorization for self-administration of medication signed by the child's parent or guardian and an authorized prescriber is submitted to the school nurse; and (C) diabetes to (i) check blood glucose levels when needed, (ii) administer insulin with an insulin delivery system used by the student, (iii) treat hypoglycemia and hyperglycemia and otherwise attend to the care and management of his or her diabetes, and (iv) possess the supplies and equipment necessary to monitor and treat diabetes, including, but not limited to, glucometers, lancets, test strips, insulin, syringes, insulin pens and needle tips, insulin pumps, infusion sets, alcohol swabs, a glucagon injection kit and glucose tablets. Any activity undertaken by a student pursuant to this subparagraph shall be in accordance with the student's diabetes care plan. The regulations shall require authorization pursuant to: [(i)] (I) The written order of a physician licensed to practice medicine in this or another state, a dentist licensed to practice dental medicine in this or another state, an advanced practice registered nurse licensed under chapter 378, a physician assistant licensed under chapter 370, a podiatrist licensed under chapter 375, or an optometrist licensed under chapter 380; and [(ii)] (II) the written authorization of a parent or guardian of such child. |
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| 61 | 61 | | |
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| 62 | 62 | | (d) [(1)] With the written authorization of a student's parent or guardian, and [(2)] pursuant to the written order of [the student's (A)] (1) a physician licensed to practice medicine, [(B)] (2) an optometrist licensed to practice optometry under chapter 380, [(C)] (3) an advanced practice registered nurse licensed to prescribe in accordance with section 20-94a, or [(D)] (4) a physician assistant licensed to prescribe in accordance with section 20-12d, a school nurse and a school medical advisor may jointly approve and provide general supervision to an identified school paraprofessional, including a school-designated care aide, to (A) administer medication, including, but not limited to, medication administered with a cartridge injector, to a specific student with a medically diagnosed allergic condition that may require prompt treatment in order to protect the student against serious harm or death; (B) administer insulin; and (C) program a student's insulin delivery system or supervise a student who programs his or her insulin delivery system. For purposes of this subsection, "cartridge injector" means an automatic prefilled cartridge injector or similar automatic injectable equipment used to deliver epinephrine in a standard dose for emergency first aid response to allergic reactions; and "insulin delivery system" means a portable device used by individuals with diabetes that injects insulin at programmed intervals in order to regulate blood sugar levels. |
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| 63 | 63 | | |
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| 64 | 64 | | |
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| 65 | 65 | | |
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| 66 | 66 | | |
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| 67 | 67 | | This act shall take effect as follows and shall amend the following sections: |
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| 68 | 68 | | Section 1 July 1, 2011 New section |
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| 69 | 69 | | Sec. 2 July 1, 2011 New section |
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| 70 | 70 | | Sec. 3 July 1, 2011 New section |
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| 71 | 71 | | Sec. 4 July 1, 2011 New section |
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| 72 | 72 | | Sec. 5 July 1, 2011 10-212a(c) and (d) |
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| 73 | 73 | | |
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| 74 | 74 | | This act shall take effect as follows and shall amend the following sections: |
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| 75 | 75 | | |
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| 76 | 76 | | Section 1 |
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| 77 | 77 | | |
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| 78 | 78 | | July 1, 2011 |
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| 79 | 79 | | |
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| 80 | 80 | | New section |
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| 81 | 81 | | |
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| 82 | 82 | | Sec. 2 |
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| 83 | 83 | | |
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| 84 | 84 | | July 1, 2011 |
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| 85 | 85 | | |
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| 86 | 86 | | New section |
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| 87 | 87 | | |
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| 88 | 88 | | Sec. 3 |
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| 89 | 89 | | |
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| 90 | 90 | | July 1, 2011 |
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| 91 | 91 | | |
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| 92 | 92 | | New section |
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| 93 | 93 | | |
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| 94 | 94 | | Sec. 4 |
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| 95 | 95 | | |
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| 96 | 96 | | July 1, 2011 |
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| 97 | 97 | | |
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| 98 | 98 | | New section |
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| 99 | 99 | | |
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| 100 | 100 | | Sec. 5 |
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| 101 | 101 | | |
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| 102 | 102 | | July 1, 2011 |
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| 103 | 103 | | |
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| 104 | 104 | | 10-212a(c) and (d) |
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| 105 | 105 | | |
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| 106 | 106 | | Statement of Purpose: |
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| 107 | 107 | | |
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| 108 | 108 | | To ensure that students with diabetes receive proper medical care while at school. |
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| 109 | 109 | | |
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| 110 | 110 | | [Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.] |
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