School health programs should be cautious about inserting themselves between
a physician and a patient or between a parent and a child when providing
medical care for children. It has become common practice to take medicines
away from school children and insist that the child come to the office or the
nurse for treatment. If the school is prepared to take responsibility for
administering the medicine properly and on time and if the teacher or nurse
can be sure that the child leaves with the medicine so that nighttime doses can
be given, the school may not increase its legal risks by doing this. It also does
not reduce its risks.
This policy can lead to major problems for the school in two situations. If the
school nurse or physician does not agree with the prescriptions of the
attending physician and prevents the child from following the physician’s
orders, then the school personnel would be liable for any harm that came to
the child because of the lack of medical care. A school nurse or doctor who
substituted other medical care for that prescribed by the attending physician
would be liable for rendering care without legal consent. It is wise to
remember that for a physician or a nurse, telling a patient not to do something
is an act of medical judgment.
The other serious problem involves situations when it is medically important
that the patient control his or her own medications. The asthmatic child cannot
use inhalers on demand if the inhalers are in the nurse’s office. The attack that
could have been aborted by the inhaler in the pocket may require emergency
care in the time it takes to find the person with the key to the medicine locker.
If responsibility is a central issue in the patient’s care, then no amount of
planning by the school nurse can make up for the harm done by removing
medications. Adolescents with diabetes are typically very hard to maintain in
control. They shift from denial to dependence very quickly. They must
cooperate with their physicians and their parents and a host of others. If the
school officials are not active participants in this child’s care program, they
should not interject themselves into the care.