HEALTH CARE RESPONSIBILITIES IN SPECIAL EDUCATION

Over a decade ago, Congress passed legislation (Section 504 of the Rehabilitation Act of 1973 and P.L. 94-142) designed to guarantee all disabled students the right to a free, appropriate public education. Consequently, large numbers of youth with physical or mental disabilities, who previously were underserved or who had not been served at all by the public schools, benefited tremendously.

The good accomplished by this legislation is undeniable. Questions, however, remain about what constitutes appropriate care for students who require health care services outside those traditionally offered by the public schools. Part of the answer lies in whether adequate funds and services follow children placed in least restrictive environments, including both regular and self-contained special education classrooms. More basic, however, is the question of whether qualified people are giving these students the special medical care and services their individual disabilities require. Mounting evidence indicates that this may not be the case.

Many school districts do not employ school nurses. Of those that do, the school nurses often serve multiple buildings. With more students needing sophisticated medical services during school hours, school systems are faced with a dilemma. They are required to provide such services but do not have the necessary qualified personnel. In this situation, the public might expect a careful analysis by educators and the medical community of students' medical needs and the qualifications required of those who will attend them. Instead, it is often the case that school nurses are among the first to be released during budget cuts, and non-medical personnel are assigned to assume these responsibilities. Despite the fact that they are given little or no training and are not covered by liability insurance, refusal by the non-medical staff to perform such tasks may result in charges of insubordination and the loss of one's job. School employees, in this case, are effectively silenced in protesting what at the least could be a potentially harmful situation and at the worst, life-threatening child neglect. Likewise, parents fear removal of their children from the public school program or other retaliation.

What is the nature of this neglect? A significant number of special education students require health services during school hours, such as catheterization, scheduled administration of medication, tube feedings, diaper changing, lifting, injections, and suctioning tracheotomy tubes. Teachers and paraprofessionals, in both regular and special education, and other school-related personnel are being required to provide these medical services. Although all carry out these responsibilities to the best of their abilities, there is concern that these requirements may exceed their job descriptions and, more importantly, their recognized areas of competence. Each state has a nursing practice law that defines specific duties included under nursing licensure. To perform these duties without a license violates the law. The aforementioned school responsibilities must be compared to duties proscribed by nursing licensure laws. Questions should also be raised as to whether special education students are being treated as second-class citizens and whether school employees are being compelled to give medical services that are illegal, because the provision of such services is restricted to licensed health care professionals.

Many deaths have occurred in nursing homes, for example, because poorly trained personnel have caused feeding tubes to dislodge, resulting in food going into the lungs rather than the stomach. Some deaths have already occurred in schools. Although dispensing medicine may seem like a fairly simple task, there can be serious problems. Untrained personnel are not taught to recognize myriad side effects, many of which require immediate medical attention. Also, personnel responsible primarily for other tasks, such as teaching, are easily caught up in a lesson and can lose track of time. Here again, the child's health and welfare are endangered. Improper lifting of disabled students can cause injury to both the student and the person doing the lifting. The complexities of catheterization, tracheotomy suctioning or administering injections are more obvious.

Because the AFT believes that special education students have the right to full educational opportunity in the public schools and that this right should in no way jeopardize their life, health or well-being; and

Because the AFT also believes that teachers, paraprofessionals and other school-related personnel should not be required to perform duties for which they are not qualified, especially when legal liability is in question and when refusal to carry out such tasks may mean the loss of their livelihoods on the basis of insubordination:

RESOLVED, that a committee on health care responsibilities in special education, which would include representatives of teachers, paraprofessionals and school-related personnel (PSRP) and nurses and health care professionals (FNHP), be formed by the AFT executive council to study the issue of who is qualified to provide medical services to special education students in public schools, to research the scope of the current problem and to make recommendations to guide policy in safeguarding these students' lives and health when in the care of the schools.