April 6, 2010

Re: Student Additional 504 Services Request

Dear Mr. Lemoine, Ms. Marix, Ms. Dehm, and Ms. Vidos:

I am writing to formally request additional 504 services for my child, Student,

a six-year-old with type 1 diabetes who attends School. My goal is to make
sure that she receives diabetes care and medication when needed at school
and school-related events. While I appreciate the efforts of the school’s part-
time school nurse and school staff, my repeated requests for staff to be
trained and for a written plan to be put in place to address Student’s
diabetes needs when the part-time nurse is not on duty have not been
fulfilled. As a result, Student has had dangerous low blood glucose
levels (hypoglycemia) and high blood glucose levels
(hyperglycemia) at school with no one there to administer insulin or
glucagon to her to treat those conditions, and she has not been
allowed to participate in school events that involve food because no
one was available to administer insulin to her.

Children with type 1 diabetes require monitoring of their blood glucose,

which fluctuates more than in children who do not have diabetes, throughout
the school day by using a finger prick and a handheld device called a glucose
meter. They also require insulin injections before eating, and when they have
hyperglycemia. Student wears an insulin pump, which looks like a beeper
connected to a flexible tube that is left inserted under her skin. Insulin is
administered by pressing buttons to tell the machine how much insulin to
deliver. If a student with diabetes has hypoglycemia, trained staff must
immediately feed the student something sugary, and if this does not happen
or fails to raise the child’s blood sugar, she will lose consciousness or have
seizures and require an immediate injection of emergency glucagon.
Student’s school only has a nurse for lunchtime, but I am not asking
Lafayette Parish to provide a full-time nurse at Student’s school. Rather, the
American Diabetes Association and the diabetes health care professional
community strongly support a school diabetes care model where the needs
of students with diabetes can be safely met by trained lay personnel – both
during the school day and during extracurricular activities and field trips.
See National Diabetes Education Program, Helping the Student with Diabetes
Succeed: A Guide for School Personnel, available at
http://ndep.nih.gov/media/Youth_NDEPSchoolGuide.pdf (last accessed March
4, 2010). In this model, which has been successfully implemented in
schools nationwide, the school nurse provides diabetes care when she is
available and on-site and, when a nurse is unavailable, diabetes care is
provided by trained non-medical school personnel. Training should include
blood glucose monitoring, recognition and treatment of hypoglycemia and
hyperglycemia, supervising the self-administration of insulin, and
administration of glucagon. Glucagon is an emergency injection designed for
lay-people to use and may legally be administered by unlicensed school staff
in Louisiana. LA. ADMIN. CODE tit. 28, § 1129 (2010) (lay personnel may
administer injectible medication in an emergency). Section 504 of the
Rehabilitation Act requires Lafayette Parish to provide someone–whether a
school nurse or trained school staff–to help Student self-administer insulin
through her insulin pump (which she can operate with adult supervision) and
administer emergency glucagon to her if needed at any time during the
school day, as well as on field trips. Please see the enclosed decisions from
the U.S. Department of Education’s Office for Civil rights, finding school
districts not in compliance with 504 because the districts failed to provide
trained school staff who were physically present at school to administer
insulin, glucagon, and other diabetes care at the school at all times and on
field trips and extracurricular activities. See Kiski (PA) Area Sch. Dist., No.
03-07-1258, 109 LRP 32695 (OCR 2008); Clovis (CA) Unified Sch. Dist., 52
IDELR 167, Complaint No. 09-08-1395 (OCR 2009). Lafayette Parish has
acknowledged that Student is covered by Section 504 and has issued her a
504 Plan, although the plan is not currently detailed enough to enable
Student’s teachers to know what to do in an emergency or to address the
times that she needs insulin and the nurse is unavailable.

I have repeatedly requested that provisions be made to ensure that Student

gets the diabetes services she needs at school. She has repeatedly been left
out of “king cake” celebrations in class because she needs insulin in order to
eat the king cake. This may seem like a small thing, but under Section 504,
the school cannot exclude Student from activities- even activities like eating
king cake- because of her diabetes. If the school is going to have king cake
celebrations, they must make arrangements for Student to participate, which
merely requires training a staff person to supervise her while she administers
insulin via her pump. Therefore, I request that multiple school staff receive
child-specific training so that they know how to help Student self-administer
insulin, and how to treat hypoglycemia and administer emergency glucagon.
Student’s treating endocrinologist, Dr. Flint, has offered to perform such
training at no cost. Additionally, Student’s 504 plan needs to include
detailed directions for her teachers regarding Student’s needs, who to call if
Student needs help with diabetes care, and to receive a basic training
explaining diabetes and the directions in the 504 plan.

Please help make sure that Student can go to school safely. I appreciate the
efforts of school staff thus far to meet Student’s needs, but I am very
concerned that Student experiences hyperglycemia and hypoglycemia at
school and there is frequently no one there to give her the medication she
needs. I have a full-time job and may not get to school in time to help
Student. Furthermore, under Section 504, it is the school’s responsibility to
meet her basic disability needs during school and school events. The care
she requires is so simple. A short training by Dr. Flint of school volunteers
and some written instructions in Student’s written plan would protect her
from harm and fulfill Lafayette Parish’s obligations. I would like to have a
504 meeting with you and the members of Student’s 504 team to arrange
the training and agree upon the changes to Student’s written plan. Please
contact me by e-mail at my email or by phone at my phone.

Sincerely,

ME

Enclosures (2)