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Calif. Teachers Request End to Medical Duties

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The California Teachers Association is lobbying the legislature to pass a controversial bill that would prohibit teachers from providing medical services that some students may require in the classroom.

The union argues that leaving teachers with the responsibility for handling the medical treatments needed by some students puts the children at risk of harm and the teachers at risk of being held legally liable if problems result.

The legislation, which was passed by the Assembly's health committee last week, would separate the role of teacher and health-care worker in schools and take the often overlapping responsibilities out of teachers' hands.

In an effort to "mainstream'' special-education students, more and more "medically fragile'' children are coming to school, the teachers say.

In the absense of qualified health-care personnel, teachers are often designated by administrators to perform certain procedures, such as giving injections, cleaning catheters, performing gastronomy feedings, or suctioning a tracheotomy tube.

When teachers are responsible for such tasks, the legal risk to the school district is tremendous, said Edward Foglia, CTA president.

"There has been a trend in California to cut costs on the use of school nurses,'' he noted. "If school districts are going to cut back on health-care personnel but increase the number of kids with special needs, they are going to have to go out and get somebody to take care of them.''

Though there have been no liability suits involving teachers who performed medical services for a student, Mr. Foglia said, "it's just a matter of time.''

The legislation, which was introduced by Assemblyman Jack O'Connell of Santa Barbara, chairman of the education committee, would provide resources for school districts to hire the needed health personnel, according to Richard H. Simpson, a consultant for the education committee.

An estimated $2 million to $4 million in state funding will be required for the additional staff, he added.

The bill is currently before the Assembly's ways and means committee, where the financing will be discussed.

The bill does not address the question of who should provide the health-care services if teachers do not.

California law currently states that teachers can perform certain medical services under supervision of a registered nurse, physician, or licensed health-care aide, according to Marilyn M. Ryan, program specialist for school nursing services in the Los Angeles County schools.

"Supervision'' may mean talking over the phone or simply being "on call'' in case of emergency, she explained.

But Frances Wright, a spokesman for the California Board of Registered Nursing, said her members are concerned about the qualifications and training levels of those delegating medical chores to teachers.

"Even some school nurses, who have a public-health background, are not trained to perform some procedures,'' Ms. Wright said.

Fewer School Nurses

The number of school nurses across the country is declining, according to Judith Ressallat, a spokesman for the National Association of School Nurses.

No state requires that every school district hire a school nurse, and only 11 states mandate that districts provide some type of health services.

When administrators look for ways to cut budgets, school nurses are often the first to go, she said.

Bills that would determine who would be responsible for school health services have been proposed in Ohio, Kansas, and Louisiana.

In Iowa earlier this month, the local board of nursing challenged the legality of delegating nursing duties to teachers.
The board issued a strong statement recommending that each school district employ a registered nurse--not unlicensed personnel--to provide school health services.

School officials estimate that one-third of Iowa's 436 districts do not employ registered nurses.

Earlier this year, an amendment requiring schools to hire registered nurses was dropped from an education bill because it was not financially feasible, a state spokesman said.

The Education for All Handicapped Children Act, P.L. 94-142, holds schools responsible for providing some medical services to the handicapped. The law's language was further interpreted by the 1984 U.S. Supreme Court ruling in Irving Independent School District v. Tatro, which determined that the Texas school district must provide clean, intermittent catheterization to a child suffering from spina bifida.

Experts say some lower-court rulings have blurred the legal distinctions of that case, however, and many are watching the action in California, hoping it will clear up a muddied issue.

"We don't blame teachers for not wanting to practice medicine,'' Ms. Wright of the nursing board said. "But we have to deal with the scary situation of putting an ill child in a classroom without a caregiver.''

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