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on Thursday, August 12th, 2010 at 1:58 pm by Radley Balko
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I consider myself as a union supporter for the most part, but that woman needs to experience an epileptic seizure herself. What she said is just wrong on so many levels. The point about CPR says it all.
It is a no brain er. If I was a teacher and the parents came to me with that drug and taught me how to use it, I would if I needed to and to hell with the law. I would rather rot in jail for trying to help than to live free with the knowledge that I let a kid die.
At one time Unions were needed and helped. Now they are lead weights around the necks of all there members and society in general. Good riddance to most of them I say.
However, using children with seizures as a lever to bash unions, now that’s totally fine.
Are you arguing that the union’s behavior in this case isn’t reprehensible? Or that any portion of the video is false?
If the union is indeed opposing making this medication available for children unless schools hire more union nurses, do you disagree with the assessment that the union is taking a morally dubious stand?
hilzoy fangirl |
August 12th, 2010 at 6:22 pm
I think that the union representative in the video took a position that is not obviously wrong – that children with a rare, dangerous condition who need a rare, arguably dangerous drug should receive that drug from medical professionals, not teachers.
Having teachers inject the drug presents multiple problems, some of which she alluded to: incorrect application of the drug to a child who needs it, resulting in harm to the child; inability to deal with dangerous side effects of the drug, resulting in harm to the child; application of the drug to a child who does not need it, resulting in harm to the child; and, of course, legal liability for any harm that might befall a child due to the teacher’s administration of the drug.
The only rebuttal to these arguments were one professor saying not to worry about it, and one father saying he’s more concerned about his daughter’s life. I don’t know enough, and the video doesn’t present anything more than these conclusory statements, about whether and how much risk there would be in having teachers administer the drug. Experts apparently disagree. I’m therefore not in a position to evaluate the professor’s rebuttal. But the father’s rebuttal is obviously nonresponsive; if a teacher improperly administered the drug to his daughter in any of the aforementioned ways, and she was harmed as a result, he’d obviously have a problem with that, and may well take legal action against the school district and the teacher.
The obvious way to make everybody – and I mean everybody – happy would be to ensure that there is a qualified nurse available to administer the drug to any child that needs it. There may be a problem with that solution, which is to say there’s not enough money to hire enough nurses, but the video does not make that argument and does not provide enough information to support (or oppose) it. Maybe the union is taking a wrong position here, maybe they’re not. But this video simply doesn’t provide enough information for a viewer to form that conclusion. Concluding that the union is acting reprehensibly, based solely on the information in this video, seems to be an instance of question begging.
Matthew Brown |
August 12th, 2010 at 6:58 pm
I do think that proposals to make classroom teachers have to provide first aid in such cases needs to include some kind of legal indemnity for them, or legal and insurance coverage at the very least. Otherwise, they are being made to assume potentially huge legal consequences by their employers.
The only argument that nurses union/teacher union has is the threat of lawsuits if something goes wrong. I think that is what the nurse union rep in the vid alluded to about “how schools operate in CA”.
That said, none of this surprises me especially the one gal testifying about the molestation connection. It was also hilarious to watch that nurse union rep at the start talk about certification/training. Pretty soon you won’t be able to feed yourself without some certification of training on proper fork use.
How much do these medications cost? Who pays for it?
The proposed law would allow non-medical personnel to administer the drug “after training.” Who pays for that training?
If the answer to any of these is anything other than “the parents”, Why should these parents be able to shift the costs of their child’s medical care to others?
Oh, and how about this, suppose this kid goes into seizure and her gym teacher grabs the meds and sticks up her butt to administer but somehow does it wrong or the kid dies anyway. Does anyone here think for an instant that these parent would _not_ file suit against the school district?
I know it’s hella fun to bash unions and all, but maybe folks should consider what the real libertarian stance on this is (Hint: it’s not public funding of medical care) and the real world effect of these parents’ selfish decision to send a kid with a life-threatening medical condition packing off to public school.
You are wrong about almost everything. The video made it pretty clear that drug can be administered by non-medical personnel. It was approved by the FDA, a college of medical professionals whose sole purpose is certify the safety of a product. So to say that misapplication can occur is wrong.
No, hiring more nurses isn’t going to make everyone happy. Not only do they cost more money for tax payers, but adults should act like damn adults and take responsibility for the children under their care. To say that a drug certified to be administered by a layperson can really only be done someone else is at best immature and irresponsible. At worst, it is negligent and child endangerment.
How can a so-called licensed medical professional who supposedly took the hippocratic oath argue that it shouldn’t be administered a drug by the people it was designed to be administered by? Apparently, a medical professional in a union who is more concerned about jobs and lawsuits than actually doing her job.
hilzoy fangirl |
August 12th, 2010 at 8:18 pm
Mattocracy, I would just reiterate my point that the video provides nothing but conclusory assertions about whether the drug can be safely administered by laypeople. FDA approval does not mean that it can be used safely in every circumstance. Epinephrine (adrenaline) is approved by the FDA, but I hope we can agree that teachers should not be permitted to inject it in a student’s heart if they happen to think it is needed. There have been concerns raised about whether the epilepsy drug is safe for teachers to administer, and to dismiss them as frivolous simply because they are being advocated by unions, in order to prove that the unions are making frivolous arguments, is as I said question begging.
And again, as I said, there is possibly a cost argument to be made regarding hiring more nurses or not – but as I said, the video makes no effort to advance that argument, and you simply assume that it is true. Whether the cost of hiring more nurses is greater or less than the cost of harm done by teachers administering this drug is something that you and I can only speculate about, because no substantive information has been provided on this issue by the video.
There have been concerns raised about whether the epilepsy drug is safe for teachers to administer, and to dismiss them as frivolous simply because they are being advocated by unions, in order to prove that the unions are making frivolous arguments, is as I said question begging.
Is it okay to dismiss them as frivolous because they provide no scientific evidence that the drug should not be administered by teachers? Can we dismiss them as frivolous because the drug was administered by teachers for 10 years without evidence of any problems?
This seems like a serious issue that doesn’t lend itself to a simplistic Teacher Unions vs Kids headline. Both sides of this have valid concerns and those concerns should have at least been debated outside of committee.
I can definitely see where a teacher would not want to administer this drug. Per the National Center for Biotechnology Information:
Directions for the caregiver to administer the rectal gel:
* Put the person having seizures on his/her side in a place where he/she cannot fall.
* Remove the protective cover from the syringe by pushing it up with your thumb and then pulling it off.
* Put lubricating jelly on the rectal tip.
* Turn the person on his/her side facing you, bend his/her upper leg forward, and separate the his/her buttocks to expose the rectum.
* Gently insert the syringe tip into the rectum until the rim is snug against the rectal opening.
* Slowly count to 3 while pushing in the plunger until it stops.
* Slowly count to 3 again, and then remove the syringe from the rectum.
* Hold the buttocks together so the gel doesn’t leak from the rectum, and slowly count to 3 before letting go.
* Keep the person on his/her side. Take note of what time diazepam rectal gel was given, and continue to watch the person.
One can imagine the scenario where this is being administered. One teacher, ~20 students, and one of them falls to the ground suffering from a seizure. The teacher must react more swiftly than a school nurse or paramedic, so within 8 to 10 minutes presumably they have to move the student suffering a seizure to a private area or move their other students out of the area and find another teacher or staff member to watch the other students.
Then needs to determine if this is a “cluster or ordinary” seizure and needs to be aware of recent dosing of the student with diastat. (Diastat “should not be used more than five times a month or more often than every 5 days.”)
Then the teacher must closely watch the student for another 15 minutes at least. Again, from the National Center for Biotechnology Information:
After administering the rectal gel, the caregiver should watch the person with seizures carefully. If any of the following occur, call 911:
* seizures continue for 15 minutes after diazepam rectal gel was given (or follow the doctor’s instructions).
* the seizures seem different or worse than usual.
* you are worried about how often seizures are happening.
* you are worried about the skin color or breathing of the person with seizures.
* the person is having unusual or serious problems.
So there seem to be legitimate privacy and liability concerns for teachers and I don’t envy them being put in a position where they are not comfortable using this drug on a child. Per SB 1051: “Requires a school employee with voluntary emergency medical training to provide this emergency medical assistance in accordance with yet-to-be- established standards, and the performance instructions of the licensed health care provider of the pupil.” So if you volunteer or are pressured to volunteer to receive training, when required you must flawlessly administer this drug.
However, if a teacher does take on this additional responsibility they will be “immune from criminal or civil liability for injuries resulting from his or her acts or omissions in administering the diastat.”
hilzoy fangirl, it’s funny you mention Epinephrine. In SB 1051 it is mentioned as well, ” Current law authorizes non-medical school personnel to administer medication to a pupil in an emergency, after receiving specified training:
Emergency epinephrine auto-injectors. A prescription
for an auto-injector for a specific pupil is not
required; the prescription is for the school.
(Education Code 49414)
However, using children with seizures as a lever to bash unions, now that’s totally fine.
Yeah, I kind of agree with you on that one. Unions are so self-serving, parasitic, and unethical that trusting them with the welfare of any child is inexcusably ignorant. Surrendering the education of our children to the unions has condemned future generations to world class mediocrity and will ultimately ensure that the country does not have the collective intellectual horsepower to sustain its status as a world economic leader. So, in the sense that kids with seizures are only a tiny subset of children abused by unions, I agree with you completely that there is no need to leverage off of such a small inconsequential group to highlight a problem that is massive in scale and utterly devastating in effect.
hilzoy says: “I would just reiterate my point that the video provides nothing but conclusory assertions about whether the drug can be safely administered by laypeople.”
The training takes about 5 minutes, and administering Diastat is about as idiot-proof as it gets. My daughter suffers from these same types of rare seizures (status epilepticus), and we administer Diastat all the time. As as result of her condition, we are part of a large community of families that also use it. And based on that experience, I can assure you that it is administered successfully and safely by laypeople all over the country, all the time — I’d guess many thousands of times each day.
It is certainly easier to administer than an Epi-pen, which involves a spring-loaded needle. So is it your position that kids with serious allergic conditions also should be kept home? There are bees on the playground after all.
Diastat is certainly easier to administer than CPR, which involves critical evaluation, remembering many steps, and physical exertion. So, as has already been asked, should only doctors and nurses be allowed to perform CPR?
I’d imagine Diastat is also easier to administer than the heimlich maneuver, for that matter. Only a nurse should be allowed to intervene when someone is choking?
The fact is that any of us could be facing a life-threatening problems at any time. Any of us could choke on our food, or have a heart attack, etc. I’d much rather we have a reasoned, non-hysterical approach to allowing others to care for us in an emergency.
Of course the difference here is that we know these kids are going to have seizures, which prompts some here to say, “then keep your kid at home.” Aside from being callous, please explain how you’re going to decide then who gets to go to school? Ok, you’ve already barred my daughter and other kids with bad seizures. Check. What about those kids with allergies? Do they have to stay home because of their epi-pens? What about kids with dangerous asthma attacks and their inhalers? How about kids that have to take prescription medications during the day? And to get a bit more out there, perhaps people with really high cholesterol or a family history of heart problems should be kept out of public universities?
I suppose my point is just that if you start thinking about all the various medical needs that people might have, it is pretty telling that one like this would get singled out in this manner.
Has nobody thought to ask what the policy is in the other 49 states? One would think that you would have a lot of evidence about whether this drug is safe or unsafe to be administered by laypeople based on the experience of the rest of the country…
Love the site generally — oversight of cops, etc. is enormously important. This video, however, is total B.S. The fact that it takes 4 minutes to get to the point marks it as goofy propaganda.
Medication in school should be administered by a school nurse, it’s pretty simple, and it’s been the standard for decades. What’s the big deal? Just take the kid to the nurse, that’s what they’re there for.
Look, I’m a college teacher and I’ll come out and say it. I’ve taught at a school with a weak union, and one with a strong union. In my direct experience, unions are better for both teachers and students. Teachers are far more willing to go to bat for students they see every day than administrators in a closed office somewhere, if not intimidated by the latter.
Delta, you said: “Medication in school should be administered by a school nurse, it’s pretty simple, and it’s been the standard for decades. What’s the big deal? Just take the kid to the nurse, that’s what they’re there for.”
Why should it take longer for a person to get care inside a school than outside a school? If a person has a medical problem at the mall, any competent bystander can help in moments, but in a school we must waste important minutes finding the nurse? What if the nurse(s) are off at lunch or helping another kid? The faster these meds are given, the more effective they are.
You also said: “Teachers are far more willing to go to bat for students they see every day than administrators in a closed office somewhere, if not intimidated by the latter.”
Whether teachers are better than administrators is not at all relevant to this discussion.
As a critical care nurse married to a (gasp-union) teacher I think it’s REALLY easy to put yourself in a position where you think “common sense” should simply prevail and these nasty union folks should just step out of the way.
In my years as a RN I’ve given lots of drugs under the supervision of physicians-powerful drugs and I’ve had family members in my face over this and that:
we’ll sue you- You did too much- you didn’t do the right thing- etc etc
the whole “we know better than you” syndrome which is crazy now in america (thank you internet!).
While I think it seems easy to think this is simply a jobs bill (wow-rubbing hands -we could hire a whole nurse for each school in california yipee!).
I think it says more about the defensiveness of schools (vs. parents) than greedy unions. Our society is REALLY litigious!
My wife as a high school teacher has seen this all through her 16 year career. The only thing that makes people crazier than being with their sick family is issues with their kids.
Of course the father says ‘I’d rather them give diastat than not, the side effects for seizure are worse’
sure they are, but what if the Diastat makes the kid stop breathing, and she ends up with an anoxic head injury? Will they be so charitable then? I’m sure they’ll sue! Lay people ARE NOT good in situations of stress like administering drugs (no matter where) in stressful situations. I’ve seen MDs and RNs lose it too. Lay people are worse for the most part.
Lastly, unions do what their members want. If they don’t like a bill, they go to the capital and lobby against it. As a former shop steward as well I can tell you we didn’t cheer with glee for getting the hospital to hire one more person here or there (yipee 300 more dollars of dues-yah!).
This is a more complex issue than some folks want to make it into.
NIce anti union hit piece though.
I did read Jordan’s post before I answered. My reply to you is this: Have you ever read the packaging on a bottle of aspirin before taking them? How about any prescription medication you have ever taken? When you get prescription medication, the amount of instructions, warnings, and documentation provided is huge. Always. I won’t judge whether it is a good thing or a bad thing. Generally, I favor more disclosure than less, but at some point, the useful information gets lost in the flood of liability and regulation inspired stuff. I’ve carried epi-pens in the past as well, and the instructions provided with them are every bit as complicated and scary sounding as with those posted by Jordan for Diastat. The same is true for just about any prescription medication.
I give diastat all the time, and I know many other people who do as well. Believe me, it is not rocket science.
You know – if that bitches face was on fire, I suppose I could piss on it to put it it out. BUT, I’m not in the Firefighter’s Union; so I might not use the appropriate streaming technique.
I’d love to be there if someone she loved needed CPR or an Epi-pen to survive. “Gosh, Mrs Union Bitch – I really do wish I could help, but golly gee willikers – I’m not a member of the correct union. Besides, you wouldn’t want me to touch her chest area.”
And they wonder why people hate unions with a passion.
The amount of time it takes for someone to get a school nurse to come to a classroom could be the difference between life and death for a child with seizures. These aren’t headache’s or the flu. Quick response is vital and kids should be able to depend on credentialed, supposedly responsible and competent adults to do what is needed to save their lives with easily administered medication.
If a teacher can’t do that, they shouldn’t be a teacher…or allowed to drive a car…or have kids of their own.
I’m not trying to put down school nurses by any means, but when comparing the opinion of a school nurse to that of the entire medical, research, and pharmacuetical staff of the FDA, I’ll take the opinion of the latter.
Hearing a nurse complain about the safety of an approved product without any real argument as to why, and then calling for more staff seems rather disengenious. It’s like hearing people argue that vaccines cause autism so the government owes their family medical care because of it.
If the teachers and nurses unions were really that concerned about students, they’d outline their concerns with suggestions for improvement, not more staff.
In an alternate universe, the bill passes and three months later there’s an incensed agitator posting about a teacher jailed for molestation after an unfortunate epistat accident.
Admit it; you can imagine it easily, and in fact yes, this would deserve attention. So is it so surprising that the unions are opposed? If it were your job were on the line, instead of an opportunity to express indignation toward the government, you’d be more sympathetic.
Tim: the concerns about molestation can be readily addressed by licensing the teachers to administer Diastat, and identifying which kids might need it, and then setting up a board that reviews every single instance of administration. This gives a large degree of protection to teachers.
Dont forget that even doctors and nurses can be liable for molestation and assault.
Well I wonder what the McMartin’s, who owned a preschool in California in the 1980s would say about shoving something into a small child’s rectum, even if such penetration is approved by the FDA. Everyone does recall the McMartin child abuse case from the 1980s, right? The one where it took over 7 years, more than one criminal trial, and millions of dollars in legal fees and litigation costs to finally resolve a case which had no freakin’ way possible of having happened? I mean it was physically impossible to have occurred based on testimony of the victims and shouldn’t have gone beyond the initial complaint, with the initial complainant referred to a psychiatrist for being delusional. As a matter of fact the initial complainant subsequently was diagnosed with, and hospitalized for acute paranoid schizophrenia and in 1986 was found dead in her home from complications of chronic alcoholism before the preliminary hearing concluded. Still the trial moved forward and the lives of the people who were accused were ruined.
But that’s life in California. Maybe if there weren’t so many idiotic legal landmines in CA things could be different. Now, did I miss that the proposed law being discussed above granted immunity from prosecution/civil liability to the teacher who administered the medicine?
Hey, did you know if my car is stolen and the thief wrecks it and causes injuries that I’d be liable? I wasn’t aware of that until a couple of months ago when my brother-in-law was in a wreck with a stolen bus. While I’m happy that my BIL will be made whole by the bus company’s insurance I just don’t follow the logic of their being responsible for the thief’s actions absent gross negligence on the part of the bus company.
If my neighbor ignores a dead tree in his yard and it falls over and damages my home that’s not his liability. Well I learned that by being the neighbor that ignored the dead tree and having it squash my next door neighbor’s utility shed. I sure felt responsible for that incident. Seriously, the only reason that damage occurred was because I was too much of a cheapskate to have the tree removed.
Maybe if civil liability laws made any freakin’ sense we wouldn’t have people doing insane stuff like refusing to give life saving medicine to a child.
As a nurse, I feel I should comment on this. Some things to note.
1. Diastat is a gel form of Valium which is a Schedule IV controlled substance. I doubt that teachers would like to be held responsible for a controlled substance.
2. Diastat could cause difficulty breathing or could stop breathing all together in large enough doses. It may be difficult to tell in an emergency when a child had their last dose.
3. Caregivers have to be trained to know when Diastat should be used and should not be used. From the manufacturer’s website: Diazepam rectal gel should only be administered by caregivers who in the opinion of the prescribing physician 1) are able to distinguish the distinct cluster of seizures (and/or the events presumed to herald their onset) from the patient’s ordinary seizure activity, 2) have been instructed and judged to be competent to administer the treatment rectally, 3) understand explicitly which seizure manifestations may or may not be treated with diazepam rectal gel, and 4) are able to monitor the clinical response and recognize when that response is such that immediate professional medical evaluation is required.
4. I personally would not want to risk my license by delegating the administration of this medication to an untrained layperson. Nurses go to school for years to become experts in their profession and a lot of this cannot be taught in quick class for someone without medical experience.
Good to see that the libertarians here are just as mindlessly influenced by “think of the children” arguments as anyone else. Just wait until a teacher unnecessarily doses someone with diastat out of fear and to avoid a lawsuit; or fails to act for similar reasons; or makes a mistake. I’m sure no one here will then hesitate to blame whatever they want for that, and maybe then they’ll even be right about it. But if someone whose career would be involved in the fiasco tries to show some foresight, ah yes, then they’re a corrupt child-killing unionist.
Libertarians: good ideas, but only ever in retrospect. Maybe I should start listening to the objectivists instead. I do hate them, but at least they do try to figure things out consistently and in advance.
As a parent who had to carry Diastat around for a year because my son had some seizures, a few points:
-This drug is prescribed by a doctor for the specific purpose of stopping a seizure. Don’t make it sound more complicated than it is–it goes up the bum. You lube the plunger, and gently push the medication in the rectum. It’s that simple. If you look at the Tampax website, they list 8 steps on how to insert a tampon. If you know how to use a tampon or can teach a girl to do it, you can be taught to use Diastat. If you can’t distinguish between a vagina and rectum, you have no business being a nurse or teacher.
-I would gladly sign a waiver that I won’t sue if you give my kid this medication in good faith of attempting to stop a seizure. To me, it’s just unconscionable school nurses and teachers would just let the kid lay there convulsing when the doctor has prescribed a specific drug to stop it. That CYA attitude is exactly the point of this video: that they care more about their own liability than a child’s health. Seizures that are stopped quickly often do not result in any permanent harm to the child. The longer seizures go on however, the more the risk increases that status epilepticus, a condition which can result in DEATH can occur.
-Many kids with epilepsy have normal development, and are just as entitled to an education as other kids. Epilepsy doctors/professionals will encourage parents to treat their kids normally, and to do all the “normal” things other kids their age do so they don’t grow up feeling somehow inferior or defective. From a medical standpoint, seizures are quite controllable. They are kids just like any other, albeit with a medical condition you adapt to, just as you would adapt if a kid broke his arm on the school playground. To say it is selfish for parents to send their kid to school with this condition shows just how breathtakingly ignorant some people are–it is precisely those sort of statements which makes these kids feel inferior. And last I checked, it’s a form of discrimination to refuse public education to a child based on their medical condition.
Those of you who are afraid a teacher will administer the drug to a child who does not need it-
A serious seizure is pretty obvious, and were I that parent, I would personally speak to each and every one of my child’s teachers to let them know exactly my child’s condition and what to do if there is a seizure. I can’t picture any teachers randomly taking off some child’s pants and sticking a syringe up his/her backside if said child isn’t convulsing uncontrollably. Not wanting to administer the medicine is one thing, but not being allowed? Ridiculous. Perhaps we need random people like me to hang out in schools to be able to care for children whose teachers aren’t allowed to.