School Health Assistant Legal Overview

1
School Health AssistantLegal Overview

• Janie Lee Hall, School Health Advocate, NW
  Region, Office of School Adolescent Health,
  NMDOH
• Reference Legal Issues in School Health
  Services, Nadine Schwab Mary Gelfman

2
Legal Overview Objectives

• Identify key federal state laws related to
  school health
• Describe criminal/civil liability and potential
  legal risks in school health

3
Sources of Law

• State federal constitutions
• State federal legislation
• Administrative regulations
• Case law (aka common law)

4
Criminal Law

• Addresses violations of criminal statutes
• Cases brought by government authority
• Standard for guilt is beyond a reasonable doubt

5
Civil Law

• Cases brought by governmental authority or an
  individual seeking compensation for harm
• Tort actions address wrongful acts committed by
  individuals against other individuals

6
Civil Law (cont.)

• Negligence is the failure to act as an ordinary
  prudent person would act in similar
  circumstances
• Malpractice is negligence by a professional,
  failure to meet the standard of care

7
Civil Law (cont.)

• Standards of care are based on
• Licensure laws regulations
• Professional standards of practice
• Policies/procedures/job descriptions
• Current practice in the community

8
Civil Law (cont.)

• To prove liability, plaintiff must find
• Duty to provide care
• Breach of that duty
• Proximate cause
• Damages (harm)
• Standard for liability is a preponderance of
  evidence

9
Federal Education Laws

• IDEA Individuals with Disabilities Education Act
  (1990)
• Entitles students with disabilities a free
  appropriate education in the least restrictive
  environment

10
Federal Education Laws (cont.)

• FERPA Federal Educational Rights and Privacy Act
• Requires educational agencies to hold all
  educational records confidential,
• Only available to parents, students over 18
  years, and those who have a legitimate
  educational interest

11
Federal Civil Rights Laws

• Rehabilitation Act/Section 504 (1973)
• Assures access to buildings, programs, and
  services
• Prohibits discrimination on the basis of handicap

12
Federal Health Laws

• HIPAA Health Insurance Portability
  Accountability Act (1996)
• Assures privacy protections of individually
  identifiable health information for covered
  entities
• Exchange of information about medications,
  treatment orders, and immunizations with the
  students medical provider is allowable.

13
Federal Health Laws (cont.)

• OSHA Occupational Health Safety Administration
  
• Obligates employers to create and maintain a safe
  working environment for employees

14
New Mexico Laws Regulations

• Public Education
• Licensure Competencies
• Screening Student Assistance
• Documentation/Record Retention
• Public Health Act
• Public Health Authority
• Confidential Services for Minors
• Childrens Code
• Child Abuse Neglect

15
NM Laws Regs (cont.)

• Nursing Practice Act
• Standards of nursing practice
• Misdemeanor to
• practice professional or licensed practical
  nursing unless duly licensed to do so
• imply that he/she is a registered nurse of
  licensed practical nurse unless duly licensed to
  do so
• Proof of a single act may result in imprisonment
  for up to one year, a fine of up to 1,000, or
  both

16
US Supreme Court Cases

• Brown v. Board of Education (1954)
• Ruled that separate schools for black children
  were not equal educational opportunity
• Mills v. DC Board of Education (1972) North v.
  DC Board of Education (1979)
• Established that children with disabilities were
  entitled to appropriate educational opportunities

17
US Supreme Court Cases (cont.)

• Hudson School District v. Rowley (1982)
• Set forth judicial standards for the
  appropriateness of a special education program
  for an individual student
• Cedar Rapids Community School District v. Garret
  F (1999)
• Ruled that nursing services required for a
  ventilator dependent student under IDEA, and
  rejected cost-balancing tests of many earlier
  court decisions.

18
Lower Court Rulings

• Mitts, Carol v. Hillsboro Union High (1990)
• Case brought by school health aide who was
  assigned by the principal to perform clean
  intermittent catheterization for a student.
• Principal was found to be practicing nursing
  without a licensenot so much because he
  assigned the task of CIC, but that he assumed the
  functions of health assessment, diagnosis
  planning.

19
Lower Court Rulings (cont.)

• Macomb Federation of Teachers v. Macomb
  Intermediate Schools (1991)
• Court issued a permanent injunction against the
  districts plan to delegate certain nursing
  procedures, reinforcing that the decision to
  delegate must be made by the professional nurse,
  and that the delegator must meet the supervisory
  standard (available for direct communication).

20
Negligence Cases

• Mogabab v Orleans Parish Schools (1970)
• 16 y.o. student became ill during football
  practice at 520 pm
• Mother notified at 645 pm, and it was she who
  called for medical assistance
• Student arrived at the hospital at 730 pm, and
  died at 230 am
• Parents sued coaches, PE supervisor, principal,
  superintendent school board

21
Negligence Cases (cont.)

• How do you think the court ruled?
• Was there a duty to provide care?
• Was there a breach of duty?
• Were there damages?
• Was there proximate cause?
• Who (if anyone) do you think was held liable?

22
Negligence Cases (cont.)

• Mogabab v. Orleans Parish Outcome
• Despite vigorous dispute about causation, the
  court found that the student more likely than
  not would have survived if he had received
  prompt medical attention
• Judgement was entered against the coaches only

23
Negligence Cases (cont.)

• Nance v. Mathews (1993)
• Case in which a school health assistant failed to
  carry out urinary catheterization, as delegated
  by the school nurse, on a student with spina
  bifida, resulting in physical injuries and mental
  trauma
• Parents sued the health assistant, nurse,
  principal, and special education director

24
Negligence Cases (cont.)

• How do you think the court ruled?
• Was there a duty to provide care?
• Was there a breach of duty?
• Were there damages?
• Was there proximate cause?
• Who (if anyone) do you think was held liable?

25
Negligence Cases (cont.)

• Nance v. Mathews Outcome
• Health assistant was found liable
• Case against the principal, school nurse, and
  special education director was dismissed, because
  delegation was within the scope of the
  supervisors responsibility, and no one could
  have predicted that the aide would neglect to
  carry out the catheterization on that day

26
Negligence Cases (cont.)

• Declout v. Orleans Parish Schools (1998)
• 18 y.o. student died of an asthma attack at
  school, after school officials delayed calling
  911 as the student requested, while trying to
  contact the mother to see if she would pay for an
  ambulance
• Parents sued the principal, guidance counselor,
  and school board.

27
Negligence Cases (cont.)

• How do you think the court ruled?
• Was there a duty to provide care?
• Was there a breach of duty?
• Were there damages?
• Was there proximate cause?
• Who (if anyone) do you think was held liable?

28
Negligence Cases (cont.)

• Declout v. Orleans Parish Outcome
• Principal found negligent for shirking his duty
  to protect the child from harm
• Guidance counselor was found negligent for
  abandoning common sense and placing rigid rules
  before a dying childs request
• School board was fount negligent for failing to
  provide adequate training for its employees and
  failing to have a clear policy on medical
  emergencies

29
Remember...

• Keep the best interest of student in mind
• Make sure accurate job descriptions, policies and
  procedures are in place
• Keep accurate records---document what you do
  (including communication)
• Maintain a positive working relationship with the
  student, family and school nurse.