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.