High School Students Carrying Medicine in School

[kikik11]

My name is Kimberly and I am new to this site. I scrolled to see if any of the questions posted matched mine but I did not see anything. This may be long so please bare with me. My 16 year old sophomore was diagnosed last summer with an airborne peanut allergy. She has eaten peanuts/products her whole life. She has had several episodes of red face and hives and benedryl has taken care of it immediately.  We have had to use epi 4 times. First, when we realized she was allergic after eating a mini snickers at a ballpark and we used a teammates pen. Second, a student slapped a Reeses wrapper on her chest and it went down her shirt and she immediately showed signs of reaction that Benedryl was not relieving. 3rd time she self injected while home alone after getting a kiss goodbye from someone who had eaten peanut butter at lunch (5.5 hrs earlier). Yesterday was the last time to use and she used AuviQ after a reaction occurred right after running 2 miles outside. It was from either the locker room peanut smell, or sharing of team water bottles during break. Benedryl was administered but she was already having breathing issues so AuviQ was given.
My issue is the school nurse is trying to say DD can not carry benedryl or zyrtec in her allergy kit with her during school. She wants it stored with her and the trainers. We have 2 different Dr. notes stating she must. Her previous high school absolutely is in agreement with us saying she is responsible and must have it.  Does anyone know of legislation or have had similar issues? We are going to meet with Admin and I want to be more prepared.  My concerns are
a) the school is large and she may not have time to get to where the benedryl is locked up quick enough.
b) the nurse is not there after school and may or may not be in her office at all times.
c) the trainers may or may not be in their offices due to multiple sports and student trainers can not carry or administer meds.
d) she goes with friends or drives home from school and will need it with her.

I know there is a big debate over epi vs benedryl and that is not my argument. Every student is different and our first line is benedryl. I appreciate any help on my legal question. Thank you all!!!


*******removed your daughter's first name and replaced with DD, by hezzier

[hedgehog]

What state are you in?  In my state there is a form for the doctor to fill out for students to self-administer.  It seems pretty standard here (I mean, the form and being allowed without any problem from the school, not that a lot of students have that order).

[CMdeux]

Okay-- your action plan and ours sound quite similar.  My DD is about the same age as yours.

This is one of those areas where the state legislation climate differs RADICALLY-- in some places, it means that your student is permitted to self-carry with a doctor's note, and in others that you have to presume that self-carry = self-administer if a student is to self-carry.  In still others, epinephrine and asthma meds are NOT exempted from school drug policy that dictates that they be kept in a central location (often locked, which is an absolute no-no medically, as you have seen).

It also depends upon what your allergist will do, documentation-wise.

I can't see any way that they can really argue the point if your physician is to indicate in VERY strong terms that "immediate" means seconds, not "a few minutes" time.  With her history of breathing problems, this seems like a no-brainer from the allergist's standpoint, too.  Delays = enhanced risk of fatality.  The SCHOOL ought to want her to self-carry, quite frankly, as it reduces their legal vulnerability if she were to suffer a fatal reaction-- because you wouldn't have the ability to sue them for a delay of care.

Just some thoughts on how you can leverage self-carrying.    There are definitely some legal precedents for delays at school, and the medical literature is FILLED with accounts of how delays play a role in fatality.

[kikik11]

We are in Texas. Her previous school of which I still teach in that district did not have a problem at all with self carry.  This is a new school for her and a different district. I am trying to find legislation I am guessing to present in our 504 meeting next week. As of right now she is carrying and until they show me legislation otherwise she will continue. I did not think I would have to go this far!

Thank you for your replies!!

[ajasfolks2]

So I'm understanding correctly, the epinephrine (either Epipen or AuviQ) is going to be allowed as self-carry but NOT the Benadryl or Zyrtec?

If that's the case, I can understand:  with the current anaphylaxis management push hard on folks to NOT wait and use the epinephrine FIRST, this would mean that the student needs to notify the nurse ASAP if there is any reaction or symptoms so that the student doesn't mistakenly take the Benadryl or Zyrtec FIRST when it should be epinephrine.

Does that make sense?

What reason has school nurse specifically laid out for the no-carry of Benadryl and Zyrtec?

[kikik11]

The nurse is not wanting for "drugs" to be carried around school. It is my understanding that EPI I guess has had more legislation and therefore they are not wanting to deny. If she were in Elementary School I would understand not carrying benedryl etc. however if she were to use EPI everytime her face got red or had initial hives she would be using the pens WAAAYYY more than one should. Since your heart about pumps out of your chest and you shake uncontrollably her Dr's. and I are not OK with EPI at the first sign of a possible attack.  She has in the past taken benedryl right away and gone to the nurse or trainer and they observe....send back to class....or gave epi depending on the severity.  She is old enough to drive and old enough to learn how to self manage along with following school rules of contacting an adult.

[Macabre]

Here you go:

http://www.statutes.legis.state.tx.us/Docs/ED/htm/ED.38.htm#38.015

EDUCATION CODE

TITLE 2. PUBLIC EDUCATION

SUBTITLE G. SAFE SCHOOLS

CHAPTER 38. HEALTH AND SAFETY

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 38.015.  SELF-ADMINISTRATION OF PRESCRIPTION ASTHMA OR ANAPHYLAXIS MEDICINE BY STUDENTS.  (a)  In this section:
(1)  "Parent" includes a person standing in parental relation.
(2)  "Self-administration of prescription asthma or anaphylaxis medicine" means a student's discretionary use of prescription asthma or anaphylaxis medicine.
(b)  A student with asthma or anaphylaxis is entitled to possess and self-administer prescription asthma or anaphylaxis medicine while on school property or at a school-related event or activity if:
(1)  the prescription medicine has been prescribed for that student as indicated by the prescription label on the medicine;
(2)  the student has demonstrated to the student's physician or other licensed health care provider and the school nurse, if available, the skill level necessary to self-administer the prescription medication, including the use of any device required to administer the medication;
(3)  the self-administration is done in compliance with the prescription or written instructions from the student's physician or other licensed health care provider; and
(4)  a parent of the student provides to the school:
(A)  a written authorization, signed by the parent, for the student to self-administer the prescription medicine while on school property or at a school-related event or activity; and
(B)  a written statement from the student's physician or other licensed health care provider, signed by the physician or provider, that states:
(i)  that the student has asthma or anaphylaxis and is capable of self-administering the prescription medicine;
(ii)  the name and purpose of the medicine;
(iii)  the prescribed dosage for the medicine;
(iv)  the times at which or circumstances under which the medicine may be administered; and
(v)  the period for which the medicine is prescribed.
(c)  The physician's statement must be kept on file in the office of the school nurse of the school the student attends or, if there is not a school nurse, in the office of the principal of the school the student attends.
(d)  This section does not:
(1)  waive any liability or immunity of a governmental unit or its officers or employees;  or
(2)  create any liability for or a cause of action against a governmental unit or its officers or employees.
(e)  The commissioner may adopt rules and prescribe forms to assist in the implementation of this section.

Acts 2006, 79th Leg., 3rd C.S., Ch. 5 (H.B. 1), Sec. 10.01, eff. May 31, 2006.
Acts 2006, 79th Leg., 3rd C.S., Ch. 5 (H.B. 1), Sec. 10.02, eff. May 31, 2006.


Sec. 38.0151.   POLICIES FOR CARE OF CERTAIN STUDENTS AT RISK FOR ANAPHYLAXIS.  (a)  The board of trustees of each school district and the governing body or an appropriate officer of each open-enrollment charter school shall adopt and administer a policy for the care of students with a diagnosed food allergy at risk for anaphylaxis based on guidelines developed by the commissioner of state health services in consultation with an ad hoc committee appointed by the commissioner of state health services.
(b)  A school district or open-enrollment charter school that implemented a policy for the care of students with a diagnosed food allergy at risk for anaphylaxis before the development of the guidelines described by Subsection (a) shall review the policy and revise the policy as necessary to ensure the policy is consistent with the guidelines.
(c)  The guidelines described by Subsection (a) may not:
(1)  require a school district or open-enrollment charter school to purchase prescription anaphylaxis medication, such as epinephrine, or require any other expenditure that would result in a negative fiscal impact on the district or charter school; or
(2)  require the personnel of a district or charter school to administer anaphylaxis medication, such as epinephrine, to a student unless the anaphylaxis medication is prescribed for that student.
(d)  This section does not:
(1)  waive any liability or immunity of a governmental entity or its officers or employees; or
(2)  create any liability for or a cause of action against a governmental entity or its officers or employees.
(e)  The agency shall post the guidelines developed by the commissioner of state health services under this section on the agency's website with any other information relating to students with special health needs.

Added by Acts 2011, 82nd Leg., R.S., Ch. 590 (S.B. 27), Sec. 1, eff. June 17, 2011.

[rebekahc]

The thing is, many doctors believe (and it's probably where the school's nurse, or the district's doctor, is coming from) that benadryl and zyrtec are not life-saving medications - they can not and will not stop an anaphylactic reaction.  The only reason to use them is to make symptoms more comfortable.  So, a delay in getting one of those medications will not alter whether your DD needs epi.

Here's a thread where we discussed Bendaryl vs. Epi ... help!

[kikik11]

If I could hug you through this computer I would!!!! Thank you!!!!!

[kikik11]

My doc is an advocate for benedryl first and has her plan stating so. Of course she seeks an adult or has a buddy go get one when symptoms first start. Her Dr. orders state she should carry Benedryl, and EPI. She has also been doing a zyrtec as a preventative....which I know isnt proven but we have gone 6 months without an episode and she did not take one yesterday...ugh!

[Macabre]

Here are some food allergy management policies around the state. 

Houston ISD
http://www.houstonisd.org/cms/lib2/TX01001591/Centricity/Domain/8035/Food%20Allergy%20Guideline.pdf
Search the PDF for Texas Law for Self-Carry

Dallas ISD
http://www.dallasisd.org/cms/lib/TX01001475/Centricity/domain/148/administrative%20procedures/F13%20Administration%20of%20Medication.pdf
Search PDF for two paragraphs:  EMERGENCY MEDICATION and Self-Administration

Plano ISD
http://www.pisd.edu/parents/health/documents/PISDFoodAllergyManagementPlan_000.pdf

RISD
http://www.risd.org/Group/Parents/Health_Services/MedicationPolicy.html
has form for filling out

Austin ISD
http://archive.austinisd.org/schools/docs/health_Food_Allergy_Anaphylaxis_Awarenessv2.pdf
has form for filling out

[kikik11]

Again BIIIG HUGS!! I have been blogging since this mornings meeting with her nurse looking for these exact pieces!! We are our childrens' advocates!! (and as a teacher for those who don't have a "parental" voice)

Kim

[Macabre]

My DS (who did not have a 504 when we were in DISD and a district near Houston) is 16. I will say that in Dallas and the district near Houston, in addition to the epis in the nurse's office, he had several placed strategically throughout each campus AND he carried an epi bag from his homeroom to specials. 

He started self-carrrying epis in 4th grade (we moved out of state then).  He got a 504 in 5th grade, and it specified self-carry.  In our current state, there is just a form to fill out for it. 

He is now a high school Junior who is at school until the evening most days.  Really, all but about two weeks dureing the school year, he's there until 6:30 and sometimes until 10:00.  He HAS to have his stuff on his person.  The nurse's office is closed, as you point out.  He carries his Auvis and Benadryl (see current thread for packets we bought at CVS).  But in his plan, he goes to the nurse if he needs to take Benadryl during the school hours, as we want him observed.  He did last year after an airborne reaction.

He's clear as any of us are as to when to use one or hte other.  Which is to say, in the heat of a reaction, there is always a little doubt, but he has had the epi several times, and he is not afraid to use it.  And he knows our plan to administer if any ingestion.  (And that's in his 504).


Do you need help with any other  504 accommodations for high school?  It's a good thing you're getting a 504 now. It can be useful in college. 

(please no quoting--I'll likely remove locations)

[Macabre]

You're welcome.    It's home for me. 

We also have a Texas thread here.  I will look for it.  We should add the stuff above if it's not there.

[kikik11]

As a fellow teacher I can assure you no names or schools will be mentioned unless they have public information posted. I value my job and my own childrens privacy. I appreciate all your feedback strictly as a mom!