Seizure-Medication Bill Brings Relief in Calif.

Advocates are ecstatic that non-medical personnel will be able to administer Diastat, but nurses are concerned about misuse


Scott Martindale, Orange County Register | | Monday, October 31, 2011

ORANGE COUNTY, Calif. -- Epilepsy advocates thrilled at ability of more people to administer drug. But nurses worry about misuse.

Local epilepsy advocates are expressing relief at the passage of a state law that will allow teachers and other non-medical personnel to administer the anti-seizure medication Diastat to students beginning Jan. 1, even as nursing leaders insist that school nurses still will not train their colleagues.

SB161, authored by state Sen. Bob Huff, R-Diamond Bar, and sponsored by the Orange County Department of Education, was an effort to counter a 2009 directive by the state nursing board that urged school nurses not to train laypeople to administer the anti-convulsion medication.

Gov. Jerry Brown signed the bill into law Oct. 7, despite fierce opposition from nursing unions and their allies.

"We're just overjoyed," said Jill Cabanillas, executive director of the Epilepsy Alliance of Orange County. "It's hard enough to have a child with special needs - parents already have to fight the insurance companies and bureaucracy to get services to their children. This is just one less thing they have to fight for now."

But school nurses may not be the ones training their non-licensed colleagues to administer Diastat, the brand name for diazepam rectal gel. California nursing leaders say the new law does not change the state's Nursing Practice Act, which prohibits a nurse from training a non-licensed individual to engage in the practice of nursing.

"It's not a political issue; there is nothing in this bill to change the Nursing Practice Act," said Tricia Hunter, executive director of the American Nurses Association's California chapter. "All this law says is that a parent can designate a school employee to give Diastat. The law does not allow nurses to train non-licensed personnel to administer Diastat."

Voluntary Training
SB161 authorizes public schools in California to offer voluntary, optional Diastat training to school employees.

Parents of children with a Diastat prescription must request that their child's school offer this training to employees, and no employee can be forced or coerced to participate, according to the new law.

Leading pediatric neurologists and epilepsy advocates say a seizure that is not stopped immediately with Diastat could cause permanent brain injury or even death before paramedics even arrive on scene.

The risk of incorrectly administering Diastat is extremely low and is far outweighed by the benefits of administering the medication in a timely fashion, even if by a non-licensed school worker in the absence of a school nurse, experts have testified.

Nursing unions and their allies have vociferously disputed the risks of administering Diastat, saying that it could be given mistakenly to a convulsing student who does not need it or by a layperson who panics under pressure and delivers the wrong medication or dosage.

Diastat is administered by inserting a plastic syringe with a pre-measured dose into the patient's rectum.

"The sad part is that this law opens the door for irresponsible schools not to include a school nurse in their school district, let alone their school site," Hunter said. "We think it takes away a parent's federally given right to have an appropriate person on their child's campus to give this medication."

Hunter said that with patience and guidance, it is possible for a school district to apply for and obtain special federal funding that can pay for adequate school nursing staff. The key is knowing how to apply for these funds, Hunter said; organizations like the American Nurses Association's California chapter can assist in that effort.

'Extremely Relieved'
Parent Pat DeLorenzo of Mission Viejo, who has a 9-year-old daughter with a Diastat prescription, said he feels "extremely relieved" at the passage of SB161.

DeLorenzo's daughter, Gianna, has a full-time nurse at her school, Mission Viejo's Reilly Elementary, but even so, DeLorenzo said, he is reassured to know six laypeople at Reilly also are trained as backups.

"You shouldn't have to worry about your child's life when you send them to school," DeLorenzo said. "The biggest problem now is educating parents to be aware of their rights. I can only hope that the districts will provide the ample services the bill entails."

When the state Board of Registered Nursing declared in September 2009 that no one but a registered nurse could lawfully administer Diastat, many local schools stopped training laypeople to administer it.

But some local schools continued to train laypeople in the intervening years, using outside resources such as Diastat training courses offered by the Epilepsy Alliance of Orange County.

Now, with the law clarified, advocates hope more school districts will embrace the new legislation when it formally goes into effect Jan. 1.

"I imagine it will happen rapidly," Cabanillas said. "My gut feeling is most school districts will be happy to go back to the way it used to be."

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