Cristina,

Our understanding is that there are no laws and little in terms of
regualtions that govern epinephrine administration in schools.
Presently a 2002 directive from the New York State Department of
Education states that school nurses are permitted to train and
delegate non-nurse school personnel to administer epinephrine. The
language is clear that nurses are not required to train and
delegate. Each school presently makes such decisions on delegation
and training themselves within their own school districts and in some
cases school by school even within a district. You can view the 2002
directive at this webpage:
http://www.emsc.nysed.gov/deputy/Documents/epi-penfieldmemo.html.

New York City just 3 months ago issued new regulations related to
epinephrine in city public schools and can be found at
http://docs.nycenet.edu/docushare/dsweb/Get/Document-283/A-715.pdf.
These are good regulations (not perfect) that hopefully will serve as
a model.

Another good resource is The New York Statewide School Health
Services Center's School Health Modules - "best practice guidance"
document recently created called the "Food Allergy Module". This
state-funded organization, NYSSHSC, is under contract with the New
York State Education Department to provide technical assistance to
public schools in NYS. They are careful to say in their document
that the document is "intended for guidance" and "does not constitute
a mandate nor imply liability, should the school nurse choose other
options for care." Regardless of the language saying school nurses
do not have to follow the guidance in the draft module, it may be
useful to parents as a resource and as proof to their schools that
their own state education department considers this guidance
important to convey. My hope is that we will use this NYSSHSC module
as a part of the new state guidelines that the law requires be
developed this coming year. You can see it at:
http://schoolhealthservices.org/uploads/Draft%20Food%20Allergy%
20Module.pdf. It is still called "draft" so school nurses may not
yet have been made aware of it.

FAI is not able to provide answers to you on your specific questions
pertaining to waivers of liability and cannot comment on that
legality of such requests in schools since we are not lawyers and
have not been shown the waivers of liability documents to review.

Of course it does not make sense and would be dangerous in a medical
emergency to require a child (with no adult backup) to have to self
administer epinephrine, and of course it would make sense to have
epinephrine in or in close proximity to a cafeteria where allergens
are present. Although it is hard to imagine a school taking chances
with the lives and health of children and somehow thinking they have
less liability by getting these waivers signed than in providing
trained school personnel to monitor food allergic students when
eating, we do not know of any laws or regulations statewide in New
York that say school nurses must always be present to administer
epinephrine and certainly do not know of any laws requiring school
nurses to delegate and train others in their absence.

The law that we just passed does not remedy these issues explicitly.
Instead, it requires state guidelines be developed by 6/30/08 to
include: (a) a procedure and treatment plan including
responsibilities for school nurses and other appropriate school
personnel for responding to anaphylactic shock; (b) a training course
for appropriate school personnel for preventing and responding to
anaphylactic shock; (c) a procedure and appropriate guidelines for
development of an individualized emergency health care plan for
children with a food or other allergy which could result in
anaphylaxis; (d) a communication plan for intake and dissemination of
information on children with a food or other allergy which could
result in anaphylaxis; and, (e) strategies for reduction of the risk
of exposure to anaphylactic causative agents including food and other
allergens.

These state guidelines will recommend specific guidelines pertaining
to epinephrine issues but will not compel schools to adopt the state
guidelines verbatim. The law requires school districts to "consider
and take action on" the new state guidelines. Our hope is that
schools will consider the "take action" clause seriously and will
adopt strong and safe policies. The language in the law is the best
we could do to get the bill passed. Time will tell how it will be
interpreted and enforced.

I am sorry these important and complex issues are not clearer. Many
schools and districts are very responsible and will protect students
to the best of their ability. The examples you have provided are I
think and hope more the exception than the norm (at least these more
extreme and irresponsible school policies) and hopefully over time
will improve.

- Robert

Robert M. Pacenza
Executive Director
Food Allergy Initiative
1414 Ave. of the Americas, Suite 1804
New York, NY 10019-2514
212-207-1975 (direct line)
917-338-5130 (fax)
rpacenza@...
www.faiusa.org