Children with Type 1 Diabetes at School

What is the role of the public (or private) school when it comes to children who have diseases which require or may require care at school, during the school day?

What is the obligation of a public school system to provide not only the greatest good for the greatest number but to provide special care for children with special needs?

An article in the New York Times Science Tuesday recounts the story of an eight year old child with type 1 diabetes who was told he could not be admitted to a private school and could not go to the public school in his neighborhood because he had type 1 diabetes. 

The mother, an oncologist, said it was all she could do not to "give the finger" to the principals of the schools in question.

There are questions of principle, of public policy here, but also practical questions and solutions.

As for the practical questions, there are simple solutions:
1/ Every state could pass a law indemnifying school staff from any legal responsibility, any lawsuit in connection with administrating care to a diabetic child or to any child with a medical problem. This would make "good Samaritans" of any staff member and remove the excuse that I can't do it because it would expose me to liability.
2/ School staff could be sent to a central training day and get the basics (which are very simple) in dealing with kids with type 1 diabetes.
3/ School boards and local governments could nullify school policies which say children cannot  give themselves needed medicines for diabetes or asthma--which is something these children do at home all the time.  Or, if the legislators are too thick to understand how much sense this makes, they can vote the funds to have a responsible adult, not necessarily a nurse, present at school for children who take medications.

As for the principle: I have not heard both sides of this argument and would very much like to hear it, but I wonder whether school systems should be given the responsibility/ burden of care for kids who have a whole spectrum of "special needs."

On the other hand, in a nation where we more or less force women to work, it is a problem that a mother who has a diabetic child or a child with asthma or seizures should be unable to place her child in a school because the adults at the school are scared to death of having to deal with a sick child.

On the other hand, public schools, as they were originally conceived, had nothing to do with anything but teaching kids how to read and write and calculate. Now they are the centers for free lunches, before and after school programs, parenting surrogates for parents who are either over burdened or inadequate.  

Polio vaccines were given at school. I remember vividly, because I fainted getting mine at age 7 and they had to call my grandmother (who happened to be visiting) to take me home. Nobody talked about canceling polio immunizations because I fainted at school and scared Hell out of the adults.

I have a patient who has a child with congenital brain malformations who has grand mal seizures in school and she is indignant that the principal at her child's school does not want to provide a nurse to administer his medications and emergency care if he needs it.  She has threatened to sue.  

To some extent, this is a matter of line drawing: How serious/life threatening is the illness? How much of a burden would it be?  

Surely, most people would agree a student in a hospital bed on IV's and a respirator would be more of a burden than any school should be asked to bear. But what if he could sit in a wheel chair? What if he didn't need the IV? Suppose he was not on a respirator but on portable oxygen? At what point does that child cross the line from being totally dependent and an unreasonable burden  to being simply a kid with "special needs?"

Is a child with Oppositional Defiant Personality Disorder a kid who the school should have to deal with? Does that kid have to be kept in classes with "normal" kids when he is disruptive?

Then there is the educational aspect to school. Remember education?

When I was in seventh grade, age 13, I used to have lunch every day with a kid who sat alone, all by himself at a big cafeteria table. Nobody would go near him. I sat down with him because he was sitting alone at that cafeteria table every day. The whole empty table and this kid alone. So I sat down across from him. He eventually looked up at me and I could see why nobody had chosen his table, even though the school was overcrowded and cafeteria tables were at a premium. He had a very large head and a nasty looking scar ran from the vertex of his head down his forehead and across to one ear.  His lips were a peculiar blue color and his eyes seemed to go in different directions and his nose ran constantly.  When he ate, his fingers could not manage a fork, not enough manual dexterity, so he forced his spaghetti in with his fingers. Not appetizing.

The first few days he said nothing to me. I wasn't sure he knew I was there, although I thought I had seen one eye flicker up in my direction once. The third day he said, "You've been here before." And I introduced myself. He told me he was not supposed to be alive. The doctors told his parents he wouldn't make it to the fourth grade, but here he was in junior high school. He had had heart and brain surgery.  

I ate with him every day that semester, but then never saw him again. He just disappeared. Maybe he died. Maybe he left school. 
I can't remember what we talked about but I know we talked.  
Other kids would glance over and look at me, eating with the freak kid, but for reasons I cannot fathom to this day, at a time when I very much cared what other kids thought of me, about my "reputation" I was drawn to this outcast.  

For some reason, it didn't bother me to think I might be ostracized for being at this kid's table. And your cafeteria table, who you got to eat with, was a big deal in junior high; it determined to some extent, who was in and who was not cool.  
And I definitely wanted to be cool. Even as a boy, I cared about my hair, my clothes, who my friends were, who thought I was cool. 
I had never read "The Hunchback of Notre Dame" or "Beauty and the Beast" and there was no "Shrek." That whole narrative of literature had no yet been popularized. 

But for whatever reason, in the case of this kid, I said, "Shove it." I'm eating with him.

Somehow, I think that experience was part of my education. Don't know exactly what I got out of it. Don't know if he got anything out of my companionship, but as far as I could tell, I was the only kid at that school of 1500 kids who ever said a word to him.

It was part of my education.