California Supreme Court Rules That Trained School Personnel May Administer Insulin To Diabetic Students

The California Supreme Court ruled Monday in American Nurses Association v. Torlakson (--- P.3d ----, Cal., August 12, 2013), that California law permits school personnel who are not licensed health care providers to administer insulin to diabetic students when there is not a school nurse present.  The Court ruled unanimously that California law expressly permits trained, unlicensed school personnel to administer prescription medication, such as insulin, in accordance with written statements of a student’s treating physician and parents.

What This Means To You

In a longstanding disagreement concerning who may administer medication in school, the California Supreme Court determined that California law permits “trained, unlicensed school personnel to administer prescription medications, including insulin, in accordance with written statements of individual students’ treating physicians, with parental consent, and that persons who act under this authority do not violate the NPA.” 

Properly trained school personnel are now permitted to administer medications to students.  Board policies should be reviewed and schools should train personnel on how to administer medication, including insulin.  Before administering medication, schools should ensure that the students have written authorization from both the student’s treating physician and parent. 


In 2007, the California Department of Education (“Department”) advised local school districts that trained school personnel who are not licensed health care providers may, when a nurse is not available, administer insulin pursuant to the medical orders of the students’ treating physicians.  The advisement was part of a settlement of a class action lawsuit in federal court that alleged California’s schools failed to ensure diabetic students received legally required health care services.

The American Nurses Association (“ANA”) filed suit against the Department (and State Superintendent of Public Instruction Tom Torlakson), alleging that the Department’s advice illegally condoned the unauthorized practice of nursing.  The American Diabetes Association (“ADA”) responded with a complaint asking the court to dismiss the ANA action.  The superior court entered judgment for the ANA, declaring the Department advisory invalid and ordering that it not be enforced.  The court of appeal approved that judgment, and ADA appealed to the California Supreme Court.


The Court focused its decision on the language of Education Code section 49423, which states: “Any pupil who is required to take, during the regular schoolday, medication prescribed for him or her by a physician and surgeon… may be assisted by the school nurse or other designated school  personnel.”  The statute adds the requirement that, “In order for a pupil to be assisted by a school nurse or other designated school personnel . . .,” the school district must obtain specific written instructions from the physician and a written statement from the student’s parent or guardian indicating a desire for the district to assist the student.  The Court determined that the addition of the phrase “or other designated school personnel” in each of those provisions plainly indicated that the Legislature did not intend to limit the authority to provide medication solely to medical professionals.

Further, in analyzing the legislative history of the statute, the Court found that it was enacted against the backdrop of a growing shortage of school nurses.  Thus, the Court said, the Legislature’s reason for enacting it was to avoid requiring children to leave school during the day for the necessary medication, or compelling their parents to pay the costs of a school visit by a physician.  The Court added, the State Board of Education (“Board”) enacted regulations that expressly declare that nurses and other unlicensed school personnel may administer medications “as allowed by law.”  The Court found, “Section 49423 and its implementing regulations plainly establish, as the Legislature, the Board and the Department intended, that unlicensed school personnel may administer prescription medications.”

The Court rejected the ANA contention that because the Nursing Practices Act (“NPA”) states that among nurses’ patient care functions is “the administration of medications,” that the phrase “as allowed by law” in the Board’s regulations limits that duty to nurses.  The language of the NPA defines the practice of nursing as functions “that require a substantial amount of scientific knowledge or technical skill.”  However, the Court found that the routine administration of insulin does not require substantial scientific knowledge or technical skill, and is therefore not a function limited to nurses under the NPA. 

The Court then analyzed the NPA’s  “medical orders exemption,” that allows any person to carry out medical orders prescribed by a licensed physician “provided, such person shall not in any way assume to practice as a professional, registered, graduate or trained nurse.”  To interpret that language, as the ANA argued, as prohibiting the administering of medication because it would “assume to practice” as a nurse, would render the entire medical orders exemption meaningless.  Therefore, the Court stated that a person carrying out a physician’s medical orders is not assuming to practice nursing and is not violating the NPA.

“Finding no merit in arguments to the contrary,” the Court opined, “we conclude California law does permit trained, unlicensed school personnel to administer prescription medications, including insulin, in accordance with written statements of individual students’ treating physicians, with parental consent, and that persons who act under this authority do not violate the NPA.”

The court of appeal’s judgment was reversed, and the case remanded for further proceedings consistent with this ruling.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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