Insulin Injections by Program Staff
More and more frequently youth-serving organizations are receiving requests, sometimes demands, to give insulin injections to kids who are in their programs. If hesitation is shown, the threat of ADA (Americans with Disabilities) action may be raised. What should you do? What does the law say? Knowing some facts may help that decision.
Injection of any medicine is governed by statute in our country. In general only qualified medical personnel are permitted to perform such a procedure. An exception is insulin – self-administered and parental-administered for young children. The law does not give the parent the right to confer such a privilege to others, but nearly half of the states do allow specially-trained personnel in the school system to administer insulin because the child is there for such long periods of time.
The ADA and its 2008 amendment specifically address the topic and reasonable accommodation must be given. That said, the law specifically states the following:
- It is not an undue burden to provide blood-sugar monitoring or to administer fruit juice when blood-sugar levels are found to be low, but all equipment, special foods, and training are the responsibility of and must be supplied by the parents.
- It may be an undue burden to provide injections; this is especially true if local legislation restricts such services to the parent or a medical professional and if adding such personnel might constitute a fundamental alteration in the program’s administration/operation.
State laws differ and are subject to change – check with your local counsel and get a current definitive answer for your locale before agreeing to administer insulin to any child.
If it is legal for you to have some of your staff trained for such care and you want to honor the parents’ wishes, remember that you should at least…
- Have the parent train enough staff members that you will always have someone present in the facility or where the programming is being done – you cannot commit to the task and then fail to perform because of lack of trained personnel, or perhaps worse yet, endanger the child because you perform with personnel who are un- or inadequately trained. Remember to have the parents train additional staff as needed.
- Require initial and periodic proficiency testing to ensure that staff fully comprehended the training even though the ensuring of competency is the parents’ responsibility, not the organization's.
- Have the parent provide a written copy of the information both to document what was presented and to use for refresher and review.
- Clearly inform any parents who request such care that although every child is supervised, such monitoring cannot meet the level of that achieved at home because childcare ratios are greater than parent-to-child ratios at home and because parents know the child far better than the childcare staff does. No trained staff person will ever be as competent in administering any medication as an experienced parent or medical care professional would be.
- Obtain a signed authorization and release from the parents regarding the injection of their children. The parents are responsible for the training content and deliverance as well as ensuring comprehension and should agree to hold harmless, agree not to sue in case of unintentional action or non-action, and agree to indemnify the trained employees and the Y as a condition of participation. The agreement should provide freedom to deviate from the prescribed protocol if it’s clear that conditions warrant alteration.
The safety of the children in your programs is paramount – before agreeing to provide specialized care be absolutely certain that:
- the child’s safety is not compromised by the parents’ zeal for him or her to experience all that he or she can experience;
- other children’s safety is not compromised because of the extra care and attention needed by this child.