Administration of Medications and Other Health-Related Services in Schools

Saskatchewan Education Report:   contact Saskatchewan Learning for a copy of the report


Contents
 
Acknowledgments

Introduction

Formation of the Committee

What We Heard

Guiding Principles

Recommendations

Conclusion

Appendices

A. Legislative Background

B. Summary of Consultation Themes

C. Legal Liability and Insurance Information Sheet

Please note that some appendices were not included in this copy of the report. Sample policies and records are available in the complete report.
 


 
 Back to: Students - Diverse Needs


Acknowledgments

This report was compiled to assist the educational partners and other community agencies to develop or revise policies and procedures related to students who may need health and personal care procedures in order to attend and access the educational program.

The report was developed by the following individuals:

Jim Hopson and Mary Reeves, League of Educational Administrators, Directors and Superintendents (LEADS)
Carol Seaberly, Saskatchewan Association of School Business Officials (SASBO)
LaVonne Beriault and Rod Luhning, Saskatchewan School Trustees Association (SSTA)
Gary Luke (chair) and Janice Charlton, Saskatchewan Education
The committee members also want to acknowledge the following individuals who were involved with the Committee:
Frank Garritty, Harry Dahlem, Sandra Dahlgren, Rhonda Robertson, Don Sangster, and Joe Zolkavich


Introduction

Students with complex health care needs have entered schools in increasing numbers during the past decade. The school population at any given time may include students who are on prescribed medications, who are at risk for anaphylactic reaction due to allergies, who require continuous health and personal care procedures, or who just have a headache.

Students who were formerly institutionalized for care and education now attend school, often in their own neighbourhood. Schools need to be reasonably safe and secure settings for students keeping in mind that schools are not medical facilities.

Canada was one of the first signatories of the United Nations Convention on the Rights of the Child. Canada as a states party shall render appropriate assistance to parents and legal guardians in the performance of their child-rearing responsibilities and shall ensure the development of institutions, facilities and services for the care of children.

The Saskatchewan Human Rights Code, and the Canadian Charter of Rights and Freedoms ensure that a student's physical or mental condition is not a sufficient justification to deny the student access to school.

The Education Act, 1995, gives every student, who is six years but has not yet attained the age of 22 years, the right to attend school and to receive instruction appropriate to his/her age and level of achievement. It is accepted that those statutes result in an obligation on school boards to accommodate to a reasonable degree students with special health care needs.

To that end, The Education Act, 1995, enables school boards to facilitate medical treatment or services and allows them to enter into arrangements with health agencies to provide health-related services.

For the information of the reader, Appendix A outlines the legislative background related to the administration of medications and other health-related services in schools.


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Formation of the Committee

Through a variety of forums, the Saskatchewan education community acknowledged the need to collaborate in examining the issues related to the administration of medication and other health-related issues in schools.

The Working Committee on the Administration of Medications and Other Health-related Services in Schools was struck with representatives from the Saskatchewan School Trustees' Association (SSTA), Saskatchewan Teachers' Federation (STF), League of Educational Administrators, Directors and Superintendents (LEADS), Saskatchewan Association of School Business Officials (SASBO) and Saskatchewan Education.

The aim of the Committee was to collectively share the responsibility for examining the issues related to the administration of medications and other health-related services in schools in a common sense and practical way.

The agreed upon Terms of Reference for the Committee follow:

The Working Committee will advise the Saskatchewan educational community on matters related to the administration of medication and other health-related services in schools. The Committee will:

- a review of current literature; - an analysis of policies and practices in Saskatchewan; and

- an analysis of policies and practices in other Canadian jurisdictions.

Human Rights Commission; Saskatchewan Association for Community Living; Saskatchewan Head Injuries Association; Parents of children with chronic health conditions; Saskatchewan Registered Nurses' Association; Saskatchewan Union of Nurses; College of Physicians and Surgeons; Saskatchewan Medical Association; Saskatchewan Association of Health Organizations; Council for Exceptional Children; Saskatchewan Society of Occupational Therapists; Saskatchewan Physiotherapy Association; Children's Advocate; Regional Interagency Committees; Canadian Union of Public Employees; and other groups/individuals identified by the Committee. - administration of non-prescription medications;

- administration of prescription medications;

- establishing respective roles and responsibilities; · safeguards for teachers and other school staff; · school board insurance policies; · legal requirements; · standards for care;

- health and safety checklists;

- protocols and procedures to address the administration of medication and other health-related needs (e.g., collaborative process to develop a student's personal care plan); and

-emergency protocols.

During the first 19 months of deliberations (May, 1996 - January, 1998), the Committee discussed the pertinent issues related to the administration of medications and other health-related services in schools and heard presentations from representatives from a broad range of professional organizations, unions, government departments, community agencies and district health boards.

At the last scheduled meeting of the Committee, January 12, 1998, the members intended to finalize the report. The representatives of the STF withdrew at that time from the Committee and asked to be disassociated from the report.

The reason given by the STF representatives was that the report would not state that "teachers are under no legal, ethical or moral obligation to administer medication or to provide any regular medical or physical health care service for pupils."

The other Committee members did not endorse that position. Rather, they believe that to effectively and efficiently meet the complex needs of children and youth with health concerns, a team of school-based and community personnel are required. Teachers are crucial members of that team.

As was the original intention of the Committee, this report was completed to assist the educational community to maintain and improve the accessibility and accommodations for all students who may need health and personal care procedures in order to attend school. The report is to assist the Educational Partners and other community agencies to develop or revise policies and procedures as appropriate.

Throughout this report, the term school personnel is used to refer to all school board employees, who come in contact with students.


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What We Heard

During the deliberations, the Committee heard presentations from representatives from a broad range of professional organizations, unions, government departments, community agencies and district health boards. A complete list of the presentations is contained in Appendix B.

The groups were invited to identify from their perspectives the present situation and the emerging issues and needs of students regarding the administration of medications and other health-related services in schools.

The following is a summary of the major themes made during the presentations:


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Guiding Principles

In formulating its recommendations, the Committee adopted the following principles to guide it:


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Recommendations

The following recommendations are based on the issues identified by the Committee. After each recommendation a brief background is presented.

1. A number of issues will be identified to the Assistant Deputy Ministers' Forum on Inter-sectoral Human Services for investigation and possible resolution.

There are increasing numbers of children and youth with medical conditions that require some medication or health procedure during the school day to allow them to attend school regularly. The lack of services in many communities and the inaccessibility of those services to school-aged children were identified frequently during the deliberations of the Committee. The areas identified were:

Presently, parents, school personnel and health district personnel are unclear as to the agency that provides certain services to school-aged children. For example, some district health boards provide occupational and physical therapy consultative services to school-aged children and the school personnel who work with them. In other cases, school boards are required to purchase those services from their health district. In some instances, parents are told by both the health district and school division that such services are provided by the other service provider.

As more communities move to providing services in an integrated manner, the legislative mandate and funding avenues for such services for school-aged children must be established for community service providers and parents. School boards and health boards require clarification regarding their respective roles in providing senrices to school-aged children and youth with health-care needs.

In consultation with school boards and district health boards, the ADMs' Forum should establish policy and/or legislation that stipulates the services provided by each sector.

2. The Minister's Working Committee on Integrated School-linked Services will be requested to develop guidelines to assist boards of education and health district boards with the development of agreements or protocols that outline how health services will be provided for students attending school and requiring such procedures.

During the deliberations of the Committee, a number of the individuals identified the need for the local health district personnel and school personnel to coordinate their respective support services and programming for children with complex health needs. The health-care management plan for the student should be coordinated through collaboration between school board and district health board personnel.

The coordination and integration of services assist families who often have additional demands placed on their time and energy as the result of meeting the complex needs of their children and ensuring their safety in everyday as well as emergency situations.

In order to effectively meet the complex needs of children and youth with healthcare concerns, local health district and school boards should develop local agreements or protocols that outline how and where specific health services are provided to the school-aged population of the community.

3. Boards of education and conseils scolaires in partnership with district health boards should determine mechanisms to provide adequate, specific training and follow-up consultation related to procedures that the school is providing to children with medication and health-related needs.

Throughout the deliberations of the Committee, participants identified the need for school personnel to have access to adequate training and consultative support.

The required specific training and consultative support is based on the individual needs of the students within a particular school. Training and follow-up consultation could include:

· first aid procedures (e.g., responding to choking, administering CPR, administration of Epipens)
· warning signs of critical situations (e.g., anaphylaxis reaction, insulin shock, seizures)
· impact of medication on learning and behaviour or side effects of medication or procedure
· prevention of health problems (e.g., removal of contaminants).
4. Boards of education and conseils scolaires should have clearly written and accessible policies to address the administration of medications and other health-related services in schools.

During the deliberations of the Committee, a number of school personnel stated how important it was to their level of comfort to understand the board policies and procedures. Some school personnel and presenters expressed concern that staff are unaware of board policy. It was also identified that parents need to understand the policies and procedures of the board.

Whenever possible, board policies should be developed in a cooperative manner with the employees of the board and parents.

Bearing in mind the best interests of students, board policies could:

It is recommended that draft policies be reviewed by the school board's legal counsel prior to adoption by the board.

5. At the school level, school personnel should be aware of board policy regarding health and personal care procedures for students and participate in the development and implementation of the management plan for the student.

During the deliberations of the Committee, school personnel indicated a willingness to work with students who have special health care needs, but they shared concerns such as "What if I hurt the child?" or "Can I be sued?"

Health-care personnel identified the need to be involved with school personnel in reviewing the level of care requirements (e.g., changes in seating and positioning) as children grow and their needs change.

School board employees who follow the policy of the board have protection under insurance and the law in situations where accidents happen (see Appendix C for more information on legal liability and insurance).

Four important components that need to be addressed when planning the educational program for a student with special health care needs:

6. The Committee members will distribute this report and/or information from this report to their respective communities, as deemed appropriate by each organization.

Throughout the deliberations of the Committee, it was identified that school personnel are asking for direction in the administration of medications and other health-related services in schools.

It is the intention of the Committee that this report will assist in alleviating the anxiety that some school personnel have related to the administration of medication and other health-related services in schools.

Once the education community has reviewed this report, it is expected that each education organization will take the information contained in the report into consideration and review their existing positions and policies.


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Conclusion

This report was completed to assist the educational community to maintain and improve the accessibility and accommodations for all students who may need health and personal care procedures in order to attend school in a safe environment.


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APPENDIX A

Legislative Background

Education in Saskatchewan promotes the development of caring and responsible people who are equipped to meet the challenges of a complex and rapidly changing world. All students require an approach to education that meets their unique needs and the needs of their communities.

The Education Act

142 (1) Subject to the other provisions of this Act, every person who has attained the age of six years but has not yet attained the age of 22 years has the right:
(a) to attend school in the division where that person or that person's parents or guardians reside; and
(b) to receive instruction appropriate to that person's age and level of educational achievement.

(2) A person's right to receive instruction mentioned in clause (1) (b) is the right to instruction in courses of instruction approved by the board of education:
(a) in the schools of the school division; or
(b) subject to the stated policies, requirements and conditions of the board of education, in any schools or institutions outside the school division with which the board of education has made arrangements to provide certain services to pupils of the school division.

(3) Except as otherwise provided in this Act, the educational services provided pursuant to this section are to be provided at the cost of the school division, and no fees for tuition, transportation or any other expenses with respect to attendance at school are to be charged with respect to a pupil who is resident in the school division or whose parent or guardian is resident in the school division.

(4) Notwithstanding subsection (3), the board of education may require payment in whole or in part of costs incurred with respect to transportation pertaining to special projects or special equipment or supplies not ordinarily furnished by pupils under the policies of the board of education.

178 (1) Subject to subsections (2) to (5), every pupil shall be provided, insofar as is practicable within the policies and programs authorized by the board of education or the conseft scolaire, with a program of instruction consistent with the pupil's educational needs and abilities.

(2) Where a pupil is considered by the principal, by reason of disability, handicap or any other disabling personal attribute, to be unable to profit from the instruction ordinarily provided, the principal shall, subject to subsection 184(5), refer the matter to the director, or to the supervisory officer assigned the responsibility for pupils with special needs, for any study and evaluation that the circumstances warrant.

(3) Where a parent or guardian considers that a pupil under his or her control or custody is unable, by reason of disability, handicap or other disabling personal attribute, to profit from instruction ordinarily provided in the school, or where for similar reasons a pupil has not been enrolled in school, the parent or guardian may request the principal to refer the matter ro the director, or to the appropriate supervisory officer, for any study and evaluation as the circumstances warrant.

(4) Where a request is made pursuant to subsection (3), the principal may, in his or her discretion, determine the nature of the action to be taken on that request.

(5) Where a teacher or a parent or guardian considers that the ordinary program of instruction is insufficient to employ the superior capabilities, talents and interests of a pupil, the teacher or parent or guardian may confer with the principal with a view to determining what action the principal may consider appropriate, including referral to the director for further study and evaluation.

(6) Where a referral has been made pursuant to this section, the director or designate supervisory officer shall:
(a) direct any studies, evaluation and diagnostic procedures that may be appropriate and practicable and in conformity with the policies of the board of education or the conseil scolaire; and (b) confer with the principal, teacher, parent or guardian, pupil or any of them with respect to the results of the investigations and with respect to recommendations for alterations in the educational program of the pupil concerned.

186 (1) In this section, "pupil with a disability" includes a pupil who, pursuant to criteria prescribed in the regulations, is deemed to be unable to participate at an optimal level in the benefits of the ordinary program of the school by reason of personal limitations attributable to physical, mental, behavioural or communication disorders.

(2) Subject to regulations, a board of education or conseil scolaire shall provide educational services to pupils with disabilities, but:
(a) where it is considered advisable, the board of education or the conseil scolaire may exclude from attendance in a specific curricular program any pupil who, in the opinion of the director, is incapable of responding to instruction in that program or whose presence is detrimental to the education and welfare of other pupils in attendance in that program; and
(b) where, on investigation by and in the opinion of the director, a pupil is so seriously disabled as to be unable to benefit from any of the instructional services provided by the board of education or the conseil scolaire, the board of education or conseil scolaire shall:
(i) consult with that pupil's parent or guardian;
(ii) make available any of its consultant services that may be of assistance; and
(iii) clarify and arrange other services appropriate to the needs and circumstances of the pupil.

(3) Where a pupil is excluded from attendance pursuant to clause (2)(a), the exclusion must not deprive the pupil of access to alternative educational services provided by boards of education or conseils scolaires to pupils with disabilities pursuant to this section.

(4) A board of education or a conseil scolaire may discharge its responsibilities pursuant to subsection (2) by:
(a) providing those services within the school or in other facilities in its control; or
(b) entering into agreements with a board of education, conseil scolaire, agency, institution, the conseil general or any other person to make those services available.

(5) Where educational services are provided with the approval of the department to a pupil with a disability in a special institution in Saskatchewan or elsewhere, the responsibility of the board of education or the conseil scolaire for payment of all or a portion of the cost of maintenance, tuition, transportation and support of that pupil is that which is prescribed in the regulations.

(6) All diagnostic and investigative procedures that precede a recommendation or decision with respect to placement of a pupil in a specialized institution or program are to be conducted with the knowledge of, and in consultation with, the parent or guardian of the pupil.

(7) Notwithstanding subsections 142(3) and 173(1), a school division that, pursuant to subsection (4), has entered into an agreement to make educational services available to pupils with disabilities maintains responsibility for those pupils for so long as the parents or guardians of the pupils remain residents of the school division that entered into the agreement.

(8) Notwithstanding subsection 143(2), a conseil scolaire that, pursuant to subsection (4), has entered into an agreement to make educational services available to pupils with disabilities maintain responsibility for those pupils for so long as the parents or guardians of the pupils remain residents of the francophone education area under the jurisdiction of the conseil scolaire that entered into the agreement.

190 (1) Subject to subsection (3), a board of education, a conseil scolaire or the conseil general, or any combination of two or more of them jointly or any terms that are mutually agreed on, may provide for medical and dental examination and the treatment of pupils and of children under the age of seven years in the school division or francophone education area.

(2) Subject to the regulations, and for the purposes of subsection (1), a board of education, a conseil scolaire, or the conseil general may employ any personnel that may be determined to be necessary by the board of education, conseil scolaire or conseil general, or combination of them.

(3) No treatment mentioned in subsection (1) shall be given without the consent of the parent or guardian of the pupil or child. Notwithstanding subsections (1) and (3), a board of education or a conseil scolaire may:
(a) enter into arrangements directly with the Department of Health or any agency of that department for the provision of any of the services mentioned in this section; or
(b) participate in health service programs for schools that are conducted or coordinated cooperatively by the department and the Department of Health. Every school shall observe all laws and regulations with respect to the maintenance of standards concerning sanitation, lighting and communicable diseases.

192 A board of education or a conseil scolaire may enter into arrangements with other departments of the Government of Saskatchewan and its agencies and with agencies and individuals in the community that provide specialized services related to the health and welfare of pupils, for the purpose of maximum rationalization and coordination of those services and for the enhancement of the benefits of those services to the pupils.

The Regulations

48 (b) "high-cost disabled pupil" means a pupil with a moderate to severe
disabling condition who:
(i) requires appropriate special education services;
(ii) meets the criteria specified in section 49; and
(iii) is identified as a high-cost disabled pupil pursuant to section 50 or 51.

49 For the purposes of the Act and these regulations, a pupil is a high-cost disabled pupil if he is:

(e) orthopedically disabled, that is when assessment by a duly qualified medical practitioner certifies that the pupil's physical limitations adversely affect his educational performance, seriously restricts his mobility within the school, seriously limit self-help activities or limit his use of conventional transportation to the extent that special educational services are required;
(f) chronically health impaired, that is when assessment by a duly qualified medical practitioner certifies that the pupil's physical health:
(i) does not permit school attendance .and that hospital or home placement is required for at least three months; or
(ii) adversely affects his educational performance at school to the extent that ongoing special education services are required;
(g) socially, emotionally or behaviourally disabled, that is when a thorough diagnostic study by medical and educational personnel acceptable to the minister affirms that the pupil exhibits excessive, chronic deviant behaviour which adversely affects educational performance; or
(h) severely multiple disabled, that is when medical and psychological assessment acceptable to the minister affirms that the pupil has severe concomitant disabilities of the types described in clauses (a) to (g).

52(1) A board of education shall:
(a) make available at no cost to their parents or guardians, special education services for disabled pupils, that are, in the opinion of the minister, appropriate, including special schools, special classrooms, resource rooms and itinerant and tutorial programs, and may provide those services for preschool age disabled children identified pursuant to subsection 50(2), in order that disabled pupils and children can benefit from the most appropriate and least restrictive program;
(b) ensure that the services described in clause (a) are provided by staff with special training acceptable to the minister.

Section 13 (1) of the Saskatchewan Human Rights Code states:

Every person and every class of persons shall enjoy the right to education in any school, college, university or other institution or place of learning, vocational training or apprenticeship without discrimination because of his or their race, creed, religion, colour, sex, sexual orientation, family status, marital status, disability, nationality, ancestry, place of origin or receipt of public assistance.

Section 15 (1) of the Canadian Charter of Rights and Freedoms states that: Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age, or mental or physical disability.

Section 15 (2) subsection (1) does not preclude any law, program or activity that has as its objective the amelioration of conditions of disadvantages individuals or groups including those that are disadvantaged because of race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.


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APPENDIX B

Working Committee on the Administration of Medications and Other Health-related Services

Summary of Consultation Themes (October 1996 -June 1997)
 
GROUP REPRESENTATIVE I KEY POINTS DATE
GOVERNMENT DEPARTMENTS
 
Saskatchewan
Health
Ms Myrna Dirk · public health nurses may serve a consultative role to school personnel
· Committee should contact the Directors of Community Care for discussion on how community-based services may provide support to school population
· consultation with family to plan for accommodations
· if a parent can carry out the administration of medication or health procedure, school personnel can be trained to do same 
· community consultation and collaboration
October 30, 1996
Human Rights
Commission
Ms Pat Danforth · issues around the accommodation of needs of individuals change over time;
need to look at each on a case-by-case basis
· the rights of the child to have needs accommodated
October 30, 1996
Children's
Advocate
Council to the
Children's
Advocate
Dr. Deborah Parker Loewen
Gord Maier
· four articles from the United Nations Convention on the Rights of the Child
(1991), to which Saskatchewan and Canada are signatories, relate to the
issue under discussion:
* Article 6 - every child has an inherent right to life
· Article 18 - parties shall render appropriate assistance to parents in the
performance of their child-rearing responsibilities and shall ensure the
development of institutions, facilities and services for the care of children
· Article 23 - parties shall recognize the right of the disabled child to special
care and shall encourage and ensure that extension, subject to available
resources, to the eligible child and those responsible for his or her care, of
assistance which is appropriate to the child's condition and to the
circumstances of the parents
· Article 24 - parties shall recognize the right of children to the enjoyment of
the highest attainable standard of health and facilities for the treatment of
illness and rehabilitation of health
· the rights of the child
March 25, 1997
    PROFESSIONAL ORGANIZATIONS AND UNIONS  
Saskatchewan
Registered Nurses
Association
(SRNA)
Sue Neilson
Consultant
· "administration" of medication is dexterity (opening the bottle, taking out a pill, giving it to the person)
· "management of medication" is where information is needed on the
interactions between drugs, allergies and what to do when reactions occur
· children can be responsible for their own medications
· schools in conjunction with families must determine if they have enough
information or if they need more assistance; work collaboratively with health
nurse
· parent and physician have the major responsibility - parent has to be focus
as far as the control goes - the more central the physician and parent are, the
safer the situation will be
· schools need a process to make decisions around what needs to be done,
checks and balances in procedures
· parents and others can be taught to provide the support necessary to the
child
· children can become increasingly independent in managing their own health
needs
January 28, 1997
Saskatchewan
Union of Nurses
(SUN)
Ms Judy Junor · nurses should be administering medical procedures and medications as this
is their training and role
· health reform is changing practice; there is remote assistance but there are
liability issues
· needs of the child must be accommodated but role of registered nurses needs
to be recognized
October 30, 1996
College of
Physicians and
Surgeons
Dr. Lowell Loewen · there is a transfer of function, if other personnel are appropriately trained
they can learn a technical skill
· any procedures done in the home by parents do not require a medical degree
· liability is with the physician who trains the individual to perform the
procedure
· anything a child or a parent can learn to do, school personnel can do
December 3, 1996
Saskatchewan
Society of
Occupational
Therapists
Sharon Arndt, Parkland
Health District
Karlee Grigg, Wascana
Rehabilitation Centre
· occupational therapists break down tasks into sequential steps and make
suggestions to others
· occupational therapists do not administer anything to a child--rather assist a
child in coping with a disability
· help others to understand the difficulties the child has and assist them in
adjusting expectations of the child
· see the potential of training school personnel to provide the one-on-one
assistance to children
· would like to be more consultative with the school
· parents and school-based individuals can be trained to do therapy procedures
March 25, 1997
Saskatchewan
Physiotherapy
Association
Barb Schultz-Hurlburt
  • the emphasis of physiotherapy is on the preschool child, the earlier the

  • intervention the more effective
    · physiotherapists tend to be less involved as children enter school; school
    aged children may require ongoing daily maintenance programs
    · a physiotherapist can instruct school personnel in maintenance type of
    activities; in doing so, the individual who has been taught is responsible for
    the quality of the program
    · the most frequent PT consultation to school personnel and parents is related
    to positioning and handling
    · some school divisions are contracting services of physiotherapists to visit and
    monitor the progress of school-age children
    · school-aged children require ongoing, daily maintenance programming to
    ensure that more debilitating conditions do not occur
    December 3, 1996
    Saskatchewan
    Association of
    School
    Paraprofessionals
    Yvonne Rusnak
  • the Saskatchewan Association of School Paraprofessionals does not have a

  • statement or policy regarding the administration of medications and other
    health-related services in schools
    · Association is a professional development organization
    · Yvonne shared her personal experiences as the mother of two children with
    cystic fibrosis as well as her recent experience as a teacher associate in a
    rural school division
    · paraprofessionals need to have adequate support when they are expected to
    carry out health-related procedures
    May 13, 1997
    Canadian Union
    of Public
    Employees
    (CUPE)
    Saskatchewan Association
    of School Paraprofessionals
  • members who work in schools want appropriate and adequate training when their job includes medications and other health-related services

  • · they want follow-up and monitoring
    · would like advance notice if duties are going to change and include health related
    · if their assignment is to include health-related service should be part of the interview
    · teacher associates need information concerning insurance and liability
    · job titles should reflect role and function (i.e., teacher associate does not differentiate between those working with medically fragile and those
    working with students with reading problems)
    · appropriate training and consultative support available to school personnel concerns regarding liability and legal issues need to be addressed
    May 13, 1997
    STF Helen Argent, Resource
    Teacher, Wadena School
    and
    Leona Burkhart, Principal,
    Jean Vanier School, Regina
  • concern when parents change dosage without written request

  • · teachers prefer to take direction from other professionals rather than
    parents regarding directions and instructions related to students with health needs
    · need guidelines on procedures for permission and documentation
    · designation and training of back-up personnel in the event the designatedperson is away from school
    · some emergency situations are frightening; need for a community response
    to emergency situations
    · need for a school team approach
    · need for proper lifting procedures, including mechanical lifts, to protect staff against injuries
    · there is a lack of community supports; schools providing respite; high
    medical needs of children in Care of Social Services
    June 10, 1997
        COMMUNITY AGENCIES  
    Alvin Buckwold Child
    Development Centre
    Kinsmen Children's Centre
    Dr. Richard Snyder Medical Director · children need to become independent including self-administering of medication and self-care (i.e., catherization; self-injection of insulin)
    · therapy aides need basic training along with a basic interest in helping children and families
    · physicians recognize that children will be in school
    · a procedure is not a medical procedure and should not be called that because it is part of the child's life
    · other personnel can be taught to provide the support necessary to the child 
    · children can become increasingly independent in managing their own health needs
    March 25, 1997
    -Department of Psychiatry
    Child and Youth Royal University Hospital
    Dr. Declan Quinn

    Dr. Meinert

    · most medications, including Ritalin, can be administered outside of school hours
    · whenever possible, schools should not store medication
    · medication is just one part of "treating~' ADHD
    · needfor information concerning medications
    March 25, 1997
    Sask. Association of Health
    Organizations
    John Carter, Executive
    Director
    · Mr. Carter was unable to attend but provided a response paper for the Committee to discuss
    · need to establish liaison with health districts
    January 28, 1997
    Regina Health District Barb Beaurivage, Nursing
    Education Consultant,
    Pasqua and General
    Hospitals
    Helen Renkas, Children's
    Program, Wascana Rehab
    · goal is short-term intervention to teach the child and parents how to manage with the equipment they need--Wascana program aims to prepare the child to access the regular school · physiotherapists in the Wascana program write up the programs but do not
    provide hands-on therapy · there is an expectation that the families and other care givers provide the hands-on program
    · parents and other personnel can be taught to carry out procedures
    January 28, 1997
    Saskatchewan Association for Community Living Ms Joanne Simon · educators and school divisions are working to meet the needs of students
    · parents not insistent nurses to provide all service - it is a collaborative process with the school
    · collaboration between home and school
    December 3, 1996
    Directors of Community Care

     

    Glennys Uzelman, Greenhead

    Cecile Charlebois, Saskatoon

    Sharon deSantes, Prairie West

    Dawn McNeil, Regina 

    and

    Pat Inglis, Director of Program Development, Community Care Branch, Saskatchewan Health

     

    · there are a wide variety of practices throughout Saskatchewan health districts regarding the provision of support to school-aged children during school hours
    · with regard to ongoing, chronic health needs, family members are taught how to administer medication and patients are encouraged to self-administer · family members could teach others (school personnel) to administer medication or perform medical procedures required by a child
    · the responsibility lies with the parent when they teach someone else the procedure
    · the Directors stated that it concerned them that some teachers would withhold emergency services to a child in school because of legal liability issues
    · training in health-related procedures should be provided to more than one school-based staff so as to alleviate stress on the individuals (team approach)
    · necessary for health boards and school boards to work out how they can best assist each other 
    May 13, 1997


    Table of Contents


    APPENDIX C

    Legal Liablility and Insurance Information Sheet

    The concept of liability in administering medication and providing health care procedures in schools is discussed within the context of civil "tort" law. The purpose of civil tort law is to compensate persons who have suffered injury rather than to punish those responsible as the criminal law does.

    Determining civil liability is a process to determine whether someone has in fact been injured in a manner that the law covers and, if so, who, if anyone, should provide the compensation to the person injured.

    If a student suffers injury, the steps or tests to determine school liability for negligence can be summarized as follows:

    · Was there a duty to care for the student at the time?
    · What was the standard of care that should be provided to the student?
    · Was the standard of care breached i.e. did the school provide an appropriate level of care?
    · Did the student injury result from the inappropriate level of care being provided by the school?
    The following questions and answers address many of the issues which arise surrounding liability. The information is provided generally. It is recommended that specific questions regarding particular circumstances be referred to legal counsel.

    a) Does the school and its personnel have a duty to prevent students from being hurt?

    Yes. As soon as a student comes to school, the student is under the care and control of the school. The school is expected to provide a safe environment and to respond to dangerous situations. This duty extends to non-instructional time and off school premises where the activities are school-approved.

    b) What kind of care is the school expected to exercise?

    The courts have described the standard of care to be exercised over school children as the kind of care that would be given by aparent of a large family. As in a family setting, the age, maturity, intellectual and physical capacity of the student and the type, dangers and risks that go with the activity are some of the considerations in determining what kind of care and supervision is appropriate for a particular activity. The school is expected to assess the reasonably foreseeable risks and dangers of an activity and to guard against them.

    c) My employing board of education (conseil scolaire) has a policy that provides for administering medication as well as other personal care procedures to students. Could I be liable if the student suffers injuries from those procedures?

    Not if you were acting within the range of activities your board of education expects you to do. Section 232 of The Education Act, 1995 prevents teachers and others from being held personally responsible for student injuries as long as the injury occurred while they were acting under the umbrella of approved activities. Although you as an individual are prevented from being held liable, the board of education or conseil might be liable depending on the answers to the tests mentioned earlier.

    d) What insurance protection is in place to cover a school division and its employees when administering medication or providing health care procedures?

    Sections 85 and 86 of The Education Act, 1995, require boards of education and conseils scolaires to purchase liability insurance coverage for the board or conseil and for all their employees. All but two boards of education have purchased that insurance from a company which wrote the insurance with input from board of education representatives. That insurance is very comprehensive. The policy has been reviewed by legal counsel for the STF who has indicated that it provides fully adequate personal coverage for teachers who are involved in administering medication or providing health-related services to a student in school. The insurance provides that same wide coverage to other employees as well.

    e) Are there different tests for liability in emergency situations?

    No. The main difference between an emergency and a non-emergency is what triggers liability. Where there is an emergency, people are expected to act and to do so quickly; failure to assist is more likely to breach the standard of care rather than how the assistance is given.

    (This information is an accurate reflection of material presented to the Committee on October 15, 1997, by the solicitors of the SSTA and STF.)
     



     
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