17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT CHAPTER 9A STUDENT HEALTH SERVICES ACT SOURCE: Entire chapter added by P.L. 34-114:2 (July 18, 2018). 2018 NOTE: It appears this act does not apply to a charter school established pursuant to P.L. 29-140 (Jan. 30, 2009), codified as Chapter 12 of Title 17 Guam Code Annotated. Article 1. General Provisions. Article 2. Student Health Services. Article 3. Administration of Medications. Article 4. Specific Conditions. Article 5. Rights of Students and Parents. ARTICLE 1 GENERAL PROVISIONS § 9A101. Citation. § 9A102. General Policy. § 9A103. Definitions. § 9A101. Citation. This Chapter may be cited as the Evie Young Student Health Services Act. § 9A102. General Policy. I Liheslaturan Guåhan declares that students with serious health conditions should not be prevented from receiving critical medications in the most expedient and safe manner possible. This Chapter shall be construed to facilitate unobstructed access to health services and administration of medicines, including during emergency events, for elementary and secondary school students in Guam Department of Education schools. § 9A103. Definitions. As used in this Chapter: (a) Anaphylaxis means an allergic reaction resulting from sensitization following prior contact with an antigen which can be a life-threatening emergency. Anaphylaxis may 1 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT be triggered by, among other agents, foods, drugs, injections, insect stings, and physical activity. (b) Condition requiring prescribed medication includes any serious medical condition that requires prescribed medications, such as asthma, allergies placing the student at risk of anaphylaxis, a seizure disorder, or diabetes mellitus. (c) Health care practitioner means a physician or other health care provider who has prescriptive authority. (d) Health services means the provision of direct health care, including the administration of medication; the operation, maintenance, or health care through the use of medical equipment; or the administration of clinical procedures. (e) Medications means all medicines individually prescribed by a health care practitioner that pertain to asthma or are used to treat anaphylaxis, including, but not limited to, inhaled bronchodilators and auto-injectable epinephrine; or that pertain to diabetes, including, but not limited to, Glucagon or insulin; or that pertain to a seizure disorder. (f) School employee means an individual working in association with a Guam Department of Education school, not to include employees of charter schools, parochial schools, or Department of Defense schools. (g) Self-administration means the student’s use of his or her prescribed medication, pursuant to a prescription or written direction from a health care practitioner. (h) Superintendent means the Superintendent of the Guam Department of Education. --------- ARTICLE 2 STUDENT HEALTH SERVICES § 9A201. Student Health Services. § 9A202. Provision of Health Services, Delegation. 2 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT § 9A201. Student Health Services. (a) The Guam Department of Education shall provide leadership and assistance to schools relating to student health services. The Department, working in cooperation with the Department of Public Health and Social Services, shall provide, contract for services, or identify resources to improve student health services, including, but not limited to, the following: (1) (A) standardized protocols and guidelines for health procedures to be performed by health care practitioners and school employees. The protocols and guidelines shall include, but not be limited, to the following: (i) the delegation of nursing functions consistent with administrative rules and regulations promulgated by the Guam Board of Nurse Examiners to the extent that such rules and regulations are not inconsistent with this Chapter; (ii) training of designated nonmedical school employees; and (iii) limited appropriate documentation including, but not and recordkeeping, to, notification to school administrators and parents or guardians of the provision of health services by a school employee, including certification of medical necessity for health services signed by a health care practitioner, and informed consent by a parent or guardian for the provision of health services. (B) A copy of the protocols and guidelines shall be made available to every Department of Education school and shall be maintained by each school in a publicly available place; (2) consultation, technical assistance, and development of quality improvement measures for the Superintendent and individual Guam Department of Education schools; (3) facilitation of data collection and reporting of school health services; and 3 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT (4) information and resources that relate to the provision of school health services. (b) The Guam Department of Education shall establish or designate a position to assist in carrying out the responsibilities required under Subsection (a) of this Section. The position may be established or designated using existing personnel resources, or by contract, with an individual who: (1) holds, at a minimum, a bachelor’s degree in nursing with a master’s degree in nursing or a related field from an accredited postsecondary institution; and (2) is a registered nurse licensed under the provisions of Chapter 12 of Title 10, Guam Code Annotated. § 9A202. Provision of Health Services, Delegation. (a) Health services shall be provided in a school setting by: (1) a physician who is licensed under the provisions of Chapter 12 of Title 10, Guam Code Annotated; (2) an advanced practice registered nurse, registered nurse, or licensed practical nurse who is licensed under the provisions of Chapter 12 of Title 10, Guam Code Annotated; (3) a non-licensed health technician that has the administration of health services in his or her contract or job description as a job responsibility, and who is delegated responsibility to perform the health service by a physician, an advanced practice registered nurse, or a registered nurse, and has been trained and approved, in writing, by the delegating physician or delegating nurse for delegable health services; or (4) a school employee who is delegated responsibility to perform the health service by a physician, an advanced practice registered nurse, or a registered nurse; and (A) has been trained by the delegating physician or delegating nurse for the specific health service, if that health service is one that could be delegated by the physician or nurse within his or her scope of practice; and 4 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT (B) has been approved, in writing, by the delegating physician or delegating nurse. (i) The approval shall state that the school employee consents to perform the health service when the employee does not have the administration of health services in his or her contract or job description as a job responsibility, possesses sufficient training and skills, and has demonstrated competency to safely and effectively perform the health service. (ii) The school employee shall acknowledge receipt of training by signing the approval form. A copy of the approval form shall be maintained in the corresponding student’s record and the personnel file of the school employee. A delegation to a school employee under this paragraph shall be valid only for the current school year. (C) Nothing in this Section shall be construed to require a school employee to consent to provide health services when the administration of health services in his or her contract or job description as a job responsibility. the employee does not have (b) If at any time no school employee meeting the qualifications of Subsection (a) of this Section is available, the Superintendent shall make any necessary arrangement for the provision of the health services in order to prevent a loss of a health service from affecting students’ attendance or program participation. (c) Limitation of Liability. A school employee who has been properly delegated responsibility for performing a health service under this Section shall act as an agent of the school and be granted liability protection under the Paul P. Coverdell Teacher Liability Protection Act of 2001 (Public Law 107-110), unless the claimant establishes by clear and convincing evidence that harm was proximately caused by an act or omission of the school employee that constitutes gross negligence, willful or criminal misconduct, or 5 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT a conscious, flagrant indifference to the rights or safety of the individual harmed. (d) Nothing in this Section shall be construed to deny a student his or her right to attend a Guam Department of Education school and to receive public school services, or to deny, prohibit, or limit the administration of emergency first aid or emergency procedures. --------- ARTICLE 3 ADMINISTRATION OF MEDICATIONS § 9A301. Student Self-Administration and Possession of Medications. § 9A302. Administration of Medications by School Employees. § 9A301. Student Self-Administration and Possession of Medications. (a) The Superintendent shall permit the self-administration of medications by a student with a condition requiring prescribed medication if the student’s parent or guardian: (1) provides a written authorization to the school for the student to self-administer prescribed medication; and (2) provides a written statement from the student’s health care practitioner that the student has a condition requiring prescribed medication and has been instructed in self-administration of the student’s prescribed medications to treat the condition. The statement shall also contain the following information: (A) the name and purpose of the medication; (B) the prescribed dosage; (C) the route of administration; (D) the frequency or precise times in which the medication may be administered; 6 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT (E) the circumstances under which the medication may be administered; and (F) the length of time for which the medications are prescribed. (b) Recordkeeping. The statements required in Subsection (a) of this Section shall be kept on file in the office of the school nurse or school administrator. (c) Limitation of Liability. (1) Disclosure. The Superintendent shall inform the parent or guardian of the student that the government of Guam, the school, and its employees and agents shall incur no liability, except as provided in this Chapter, as a result of any injury sustained by the student from the self-administration of his or her prescribed medications, unless the injury is the result of gross negligence, willful or criminal misconduct, or a conscious, flagrant indifference to the rights or safety of the individual harmed on behalf of the school or its employees or agents. (2) Acknowledgment. The parent or guardian of the student shall sign a statement acknowledging that the government of Guam and the school shall incur no liability, except as provided in this Chapter, and the parent or guardian shall indemnify and hold harmless the government of Guam, the school, and its employees and agents against any claims relating to the self-administration of prescribed medications, unless the injury is the result of gross negligence, willful or criminal misconduct, or a conscious, flagrant indifference to the rights or safety of the individual harmed on behalf of the school or its employees or agents. (d) Upon request by the parent or student, the student shall have access to a private area for self-administering prescribed medication. (e) Renewal of Permission. The permission for self- administration of medications shall be effective for the school year in which it is granted and shall be renewed each following school 7 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT year upon fulfilling the requirements of Subsections (a), (b), and (c) of this Section. fulfilling (f) Possession of Medication. Upon the requirements of Subsections (a), (b), and (c) of this Section, a student with a condition requiring prescribed medication may possess and use prescribed medications when at school, during school-sponsored activities, or before and after normal school activities, including school-sponsored child care or afterschool programs and travel to and from any school-sponsored activity. (g) Diabetes Care Tasks. Upon fulfilling the requirements of Subsections (a), (b), and (c) of this Section, a student with diabetes shall be permitted to perform blood glucose checks, administer insulin through the insulin delivery system the student uses, treat hypoglycemia, and otherwise attend to the care and management of his or her diabetes when at school, during school-sponsored activities, or before and after normal school activities, including school-sponsored child care or afterschool programs. A student shall be permitted to possess on his or her person at all times necessary supplies and equipment to perform these monitoring and treatment functions. Upon request by the parent or student, the student shall have access to a private area for performing diabetes care tasks. Any training of a school employee in diabetes care tasks shall be fully consistent with training programs and guidelines developed by the American Diabetes Association. § 9A302. Administration of Medications by School Employees. (a) The Superintendent shall have at least one (1) school employee at each school who has met the requirements of § 9A202 on duty during the entire school day, including any afterschool programs, to administer or assist with the administration of the following medications: (1) inhaled bronchodilator to a student with asthma as noted in the health care practitioner’s written statement under Subsection (c)(2) of this Section; (2) epinephrine auto-injector to a student with asthma or a documented life-threatening allergy who is experiencing anaphylaxis or other conditions noted in the health care 8 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT practitioner’s written statement under Subsection (c)(2) of this Section; (3) glucagon subcutaneously to a student with diabetes who is experiencing hypoglycemia or other conditions noted in the health care practitioner’s written statement under Subsection (c)(2) of this Section; (4) insulin subcutaneously to a student, through the insulin delivery method used by the student and at the times and under the conditions noted in the health care practitioner’s written statement under Subsection (c)(2) of this Section; and (5) a seizure rescue medication approved by the United States Food and Drug Administration and any successor agency to a student with a seizure disorder who is experiencing a seizure or other condition noted in the health care practitioner’s written statement under Subsection (c)(2) of this Section. (b) Training. For those assigned the duties under Subsection (a) of this Section, training provided under § 9A202(a)(3) or (4) shall include instruction in administering the medications described under Subsection (a) of this Section, as well as recognition of the signs and symptoms of the conditions associated with those medications and the appropriate steps to be taken to respond to the symptoms and hyperglycemia, and seizures. hypoglycemia anaphylaxis, asthma, of (c) Required Written Statements. Prior to administering or assisting with the administration of any of the medications listed under Subsection (a) of this Section to a student by a school employee qualified under § 9A202(a), the student’s parent or guardian shall: (1) provide the school with a written authorization for the school employee to administer the medication at school; (2) provide a written statement from the student’s health care practitioner that the student has a condition requiring prescribed medication. The statement shall also contain the following information: 9 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT (A) the name and purpose of the medication; (B) the prescribed dosage; (C) the route of administration; (D) the frequency or precise times in which the medication may be administered; (E) the circumstances under which the medication may be administered; and (F) the length of time for which the medications are prescribed; and (3) provide the prescribed medication to the school in its unopened, sealed package with the label affixed by the dispensing pharmacy intact. (d) The statements required in Subsection (c) of this Section shall be kept on file in the office of the school nurse or school administrator. (e) Limitation on Liability. (1) Disclosure. The Superintendent shall inform the parent or guardian of the student that the government of Guam, the school, and its employees and agents shall incur no liability, except as provided in this Chapter, as a result of any injury sustained by the student resulting from acts or omissions related to the administration or the assistance in administration of any medication listed under Subsection (a) of this Section or from any reaction to any of the medications listed under Subsection (a) of this Section that a parent or guardian has authorized the school to administer to a student, unless the injury is the result of gross negligence, willful or criminal misconduct, or a conscious, flagrant indifference to the rights or safety of the individual harmed on behalf of the school or its employees or agents. (2) Acknowledgment. The parent or guardian of the student shall sign a written statement acknowledging that the government of Guam and the school shall incur no liability, except as provided in this Chapter, and the parent or guardian 10 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT shall indemnify and hold harmless the government of Guam, the school, and its employees and agents against any claims made for any injury sustained by the student resulting from acts or omissions related to the administration or the assistance in administration of any of the medications listed under Subsection (a) of this Section or from any reaction to any of the medications listed under Subsection (a) of this Section that a parent or guardian has authorized the school to administer to a student, unless the injury is the result of gross negligence, willful or criminal misconduct, or a conscious, flagrant indifference to the rights or safety of the individual harmed on behalf of the school or its employees or agents. (f) Renewal. Permission for the administration of any of the medications listed under Subsection (a) of this Section shall be effective for the school year in which it is granted, and shall be renewed each following school year. (g) Expiration Dates. The school nurse or school administrator shall check the expiration date monthly for each medication listed under Subsection (a) of this Section that is in the possession of the school. At least one (1) month prior to the expiration date of each medication, the school nurse or school administrator shall inform the parent or guardian of the expiration date. (h) The requirements of Subsections (a) to (g) of this Section shall apply only to a school that has, only to the extent that it has, a student enrolled who has a condition requiring the prescribed medication listed under Subsection (a) of this Section prescribed by the student’s health care practitioner. (i) Nothing in this Section shall be construed to require a school employee to consent to administer medications to a student if the employee does not otherwise consent to provide the health service under § 9A202(a). (j) Notwithstanding any other provision of law to the contrary: (1) the administration of any one or more of the medications listed under Subsection (a) of this Section by 11 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT school employees shall not constitute the practice of nursing and shall be exempt from all applicable statutory and regulatory provisions that restrict the activities that may be delegated to or performed by a person who is not a licensed health care practitioner; and (2) a licensed health care practitioner may provide training to or supervise school employees in the administration of any one or more of the medications listed under Subsection (a) of this Section. --------- ARTICLE 4 SPECIFIC CONDITIONS § 9A401. Life-threatening Allergies. § 9A401. Life-threatening Allergies. (a) A student who has a documented life-threatening allergy shall have: (1) an epinephrine auto-injector provided by his or her parent or guardian in his or her possession or in the possession of the school nurse, school administrator, or his or her designee, in all school environments that the student may be in, including, but not limited to, the classroom, the cafeteria, the school bus, and on field trips; and (2) a written individual health care plan in place for the prevention and proactive management for the student in all school environments that the student may be in, including, but not limited to, the classroom, the cafeteria, the school bus, and on field trips. The individual health care plan required under this paragraph may be the student’s individualized education program required under Public Law 94-142, or the student’s 504 plan required under Public Law 93-112. incorporated in (b) Each school is encouraged to keep an epinephrine auto- injector in a minimum of two (2) locations in the school, including, 12 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT but not limited to, the school office and the school cafeteria, so that epinephrine may be administered to any student believed to be having a life-threatening allergic or anaphylactic reaction. Schools electing to keep epinephrine auto-injectors shall maintain them in a secure, accessible, but unlocked location. The provisions of this Subsection shall apply to the extent that the epinephrine auto- injectors are donated to a school, or a school has sufficient funding to purchase the epinephrine auto-injectors. (c) Policies and Procedures. Each school electing to keep epinephrine auto-injectors shall implement policies and procedures for managing a student’s life-threatening allergic or anaphylactic reaction developed and approved by the Guam Education Board. --------- ARTICLE 5 RIGHTS OF STUDENT AND PARENTS § 9A501. Right of Equal Access. § 9A502. Prohibition on Parental Requirements. § 9A501. Right of Equal Access. The Superintendent shall permit a student who has a condition requiring prescribed medication to attend the same school the student would attend if the student did not have the condition. Such a student may only be transferred to a different school based on health care needs if the individualized education program team, the Section 504 team, or, if appropriate, the student’s health services team, makes the determination that the student’s health condition requires that the student’s care be provided by a licensed health care practitioner at a different school. For the purpose of this determination, the teams shall include the parent or guardian. The parent or guardian may invite the student’s treating physician to the team meeting and the team shall consider the physician’s input, whether in person or in written form, when making this determination. This determination shall be based on individualized factors the student’s health conditions. The Superintendent shall not prohibit a student who has a condition related to 13 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT requiring prescribed medication from attending any school on the sole basis that: (a) the student has a condition requiring prescribed medication; (b) the school does not have a full-time school nurse; or (c) the school does not have school employees who are trained in accordance with § 9A202 and assigned to provide care. § 9A502. Prohibition on Parental Requirements. Parents or guardians of a student who has a condition requiring prescribed medication shall not be required or pressured to provide care for the student during regular school hours or during school- related activities in which the student is a participant. For the purposes of this Section, a participant is not a student who merely observes the school-related activity. --------- 14 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 15 COL1172018 17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 16 COL1172018