Chapter 9a

17 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 1 CHAPTER 9A STUDENT HEALTH SERVICES ACT SOURCE: Entire chapter added by P.L. 34-114:2 (July 18, 201 8). 2018 NOTE: It appears this act does not apply to a charter s chool established pursuant to P.L. 29-140 (Jan. 30, 2009) , codified as Chapter 12 of Title 17 Guam Code Annotated. Article 1. General Provisions. Article 2. Student Health Services. Article 3. Administration of Medications. Article 4. Specific Conditions. Article 5. Rights of Students and Parents. ARTICLE 1 GENERAL PROVISIONS § 9A101. Citation. § 9A102. General Policy. § 9A103. Definitions. § 9A101. Citation. This Chapter may be cited as the Evie Young Student Health Services Act . § 9A102. General Policy. I Liheslaturan Guåhan declares that students with serious health conditions should not be prevented from rece iving critical medications in the most expedient and safe manner p ossible. This Chapter shall be construed to facilitate unobstructed access to health services and administration of medicines, including during emergency events, for elementary and secondary scho ol students in Guam Department of Education schools. § 9A103. Definitions.

ess to health services and administration of medicines, including during emergency events, for elementary and secondary scho ol students in Guam Department of Education schools. § 9A103. Definitions. As used in this Chapter: (a) Anaphylaxis means an allergic reaction resulting from sensitization following prior contact with an antigen which can be a life-threatening emergency. Anaphyla xis may COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 2 be triggered by, among other agents, foods, drugs, injections, insect stings, and physical activity. (b) Condition requiring prescribed medication includes any serious medical condition that requires prescri bed medications, such as asthma, allergies placing the student at risk of anaphylaxis, a seizure disorder, or diabete s mellitus. (c) Health care practitioner means a physician or other health care provider who has prescriptive authority . (d) Health services means the provision of direct health care, including the administration of medication; t he operation, maintenance, or health care through the use of medi cal equipment; or the administration of clinical proced ures.

on of direct health care, including the administration of medication; t he operation, maintenance, or health care through the use of medi cal equipment; or the administration of clinical proced ures. (e) Medications means all medicines individually prescribed by a health care practitioner that perta in to asthma or are used to treat anaphylaxis, including, but no t limited to, inhaled bronchodilators and auto-injectable epineph rine; or that pertain to diabetes, including, but not limite d to, Glucagon or insulin; or that pertain to a seizure disorder. (f) School employee means an individual working in association with a Guam Department of Education sch ool, not to include employees of charter schools, parochial schools, or Department of Defense schools. (g) Self-administration means the student’s use of his or her prescribed medication, pursuant to a prescripti on or written direction from a health care practitioner. (h) Superintendent means the Superintendent of the Guam Department of Education. --------- ARTICLE 2 STUDENT HEALTH SERVICES § 9A201. Student Health Services. § 9A202. Provision of Health Services, Delegation. COL117201817 GCA EDUCATION CH.

nt of the Guam Department of Education. --------- ARTICLE 2 STUDENT HEALTH SERVICES § 9A201. Student Health Services. § 9A202. Provision of Health Services, Delegation. COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 3 § 9A201. Student Health Services. (a) The Guam Department of Education shall provide leadership and assistance to schools relating to st udent health services. The Department, working in cooperation wi th the Department of Public Health and Social Services, shall provide, contract for services, or identify resources to imp rove student health services, including, but not limited to, the follow ing: (1) (A) standardized protocols and guidelines for h ealth procedures to be performed by health care practitio ners and school employees. The protocols and guidelines shall include, but not be limited, to the following: (i) the delegation of nursing functions consistent with administrative rules and regulation s promulgated by the Guam Board of Nurse Examiners to the extent that such rules and regulations are not inconsistent with this Chapter; (ii) training of designated nonmedical school employees; and (iii) appropriate documentation and recordkeeping,

s to the extent that such rules and regulations are not inconsistent with this Chapter; (ii) training of designated nonmedical school employees; and (iii) appropriate documentation and recordkeeping, including, but not limited to, notification to school administrators and parents o r guardians of the provision of health services by a school employee, including certification of medical necessity for health services signed by a health ca re practitioner, and informed consent by a parent or guardian for the provision of health services. (B) A copy of the protocols and guidelines shall be made available to every Department of Education sch ool and shall be maintained by each school in a publicly available place; (2) consultation, technical assistance, and develop ment of quality improvement measures for the Superintend ent and individual Guam Department of Education schools; (3) facilitation of data collection and reporting o f school health services; and COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 4 (4) information and resources that relate to the pr ovision of school health services.

on and reporting o f school health services; and COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 4 (4) information and resources that relate to the pr ovision of school health services. (b) The Guam Department of Education shall establish or designate a position to assist in carrying out the responsibilities required under Subsection (a) of this Section. The position may be established or designated using existing personnel resources, or by contract, with an individual who: (1) holds, at a minimum, a bachelor’s degree in nur sing with a master’s degree in nursing or a related fiel d from an accredited postsecondary institution; and (2) is a registered nurse licensed under the provis ions of Chapter 12 of Title 10, Guam Code Annotated. § 9A202. Provision of Health Services, Delegation. (a) Health services shall be provided in a school setting by: (1) a physician who is licensed under the provision s of Chapter 12 of Title 10, Guam Code Annotated; (2) an advanced practice registered nurse, register ed nurse, or licensed practical nurse who is licensed under the provisions of Chapter 12 of Title 10, Guam Code Ann otated; (3) a non-licensed health technician that has the

egistered nurse, register ed nurse, or licensed practical nurse who is licensed under the provisions of Chapter 12 of Title 10, Guam Code Ann otated; (3) a non-licensed health technician that has the administration of health services in his or her con tract or job description as a job responsibility, and who is del egated responsibility to perform the health service by a p hysician, an advanced practice registered nurse, or a registered nurse, and has been trained and approved, in writing, by the d elegating physician or delegating nurse for delegable health services; or (4) a school employee who is delegated responsibili ty to perform the health service by a physician, an advan ced practice registered nurse, or a registered nurse; and (A) has been trained by the delegating physician or delegating nurse for the specific health service, i f that health service is one that could be delegated by th e physician or nurse within his or her scope of pract ice; and COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 5 (B) has been approved, in writing, by the delegatin g physician or delegating nurse.

or nurse within his or her scope of pract ice; and COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 5 (B) has been approved, in writing, by the delegatin g physician or delegating nurse. (i) The approval shall state that the school employee consents to perform the health service when the employee does not have the administration of health services in his or her contract or job description as a job responsibility, possesses sufficient training and skills, and has demonstrate d competency to safely and effectively perform the health service. (ii) The school employee shall acknowledge receipt of training by signing the approval form. A copy of the approval form shall be maintained in the corresponding student’s record and the personnel fi le of the school employee. A delegation to a school employee under this paragr aph shall be valid only for the current school year. (C) Nothing in this Section shall be construed to require a school employee to consent to provide hea lth services when the employee does not have the administration of health services in his or her con tract or job description as a job responsibility.

uire a school employee to consent to provide hea lth services when the employee does not have the administration of health services in his or her con tract or job description as a job responsibility. (b) If at any time no school employee meeting the qualifications of Subsection (a) of this Section is available, the Superintendent shall make any necessary arrangement for the provision of the health services in order to preven t a loss of a health service from affecting students’ attendance or prog ram participation. (c) Limitation of Liability. A school employee who has been properly delegated responsibility for performing a health service under this Section shall act as an agent of the school and be granted liability protection under the Paul P. Coverdell Te acher Liability Protection Act of 2001 (Public Law 107-110), unless the claimant establishes by clear and convincing evidence that h arm was proximately caused by an act or omission of the sch ool employee that constitutes gross negligence, willful or crimi nal misconduct, or COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 6 a conscious, flagrant indifference to the rights or safety of the individual harmed.

ss negligence, willful or crimi nal misconduct, or COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 6 a conscious, flagrant indifference to the rights or safety of the individual harmed. (d) Nothing in this Section shall be construed to deny a student his or her right to attend a Guam Departmen t of Education school and to receive public school services, or to deny, prohibit, or limit the administration of emergency first aid or emergency procedures. --------- ARTICLE 3 ADMINISTRATION OF MEDICATIONS § 9A301. Student Self-Administration and Possession of Medications. § 9A302. Administration of Medications by School Em ployees. § 9A301. Student Self-Administration and Possessio n of Medications. (a) The Superintendent shall permit the self-administration of medications by a student with a condition requiring prescribed medication if the student’s parent or guardian: (1) provides a written authorization to the school for the student to self-administer prescribed medication; a nd (2) provides a written statement from the student’s health care practitioner that the student has a con dition requiring prescribed medication and has been instru cted in self-administration of

a nd (2) provides a written statement from the student’s health care practitioner that the student has a con dition requiring prescribed medication and has been instru cted in self-administration of the student’s prescribed med ications to treat the condition. The statement shall also contain the following information: (A) the name and purpose of the medication; (B) the prescribed dosage; (C) the route of administration; (D) the frequency or precise times in which the medication may be administered; COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 7 (E) the circumstances under which the medication may be administered; and (F) the length of time for which the medications ar e prescribed. (b) Recordkeeping. The statements required in Subse ction (a) of this Section shall be kept on file in the office of the school nurse or school administrator. (c) Limitation of Liability. (1) Disclosure. The Superintendent shall inform the parent or guardian of the student that the governme nt of Guam, the school, and its employees and agents shall incur no liability, except as provided in this Chapter, as a result of any injury sustained by the student from the self-admin istration

nme nt of Guam, the school, and its employees and agents shall incur no liability, except as provided in this Chapter, as a result of any injury sustained by the student from the self-admin istration of his or her prescribed medications, unless the injur y is the result of gross negligence, willful or criminal misconduct , or a conscious, flagrant indifference to the rights or s afety of the individual harmed on behalf of the school or its em ployees or agents. (2) Acknowledgment. The parent or guardian of the student shall sign a statement acknowledging that the government of Guam and the school shall incur no liability, except as provided in this Chapter, and the parent or guardian shall indemnify and hold harmless the government of Guam , the school, and its employees and agents against an y claims relating to the self-administration of prescribed m edications, unless the injury is the result of gross negligence , willful or criminal misconduct, or a conscious, flagrant indif ference to the rights or safety of the individual harmed on be half of the school or its employees or agents.

sult of gross negligence , willful or criminal misconduct, or a conscious, flagrant indif ference to the rights or safety of the individual harmed on be half of the school or its employees or agents. (d) Upon request by the parent or student, the stud ent shall have access to a private area for self-administerin g prescribed medication. (e) Renewal of Permission. The permission for self- administration of medications shall be effective for the school year in which it is granted and shall be renewed each following school COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 8 year upon fulfilling the requirements of Subsection s (a), (b), and (c) of this Section. (f) Possession of Medication. Upon fulfilling the requirements of Subsections (a), (b), and (c) of th is Section, a student with a condition requiring prescribed medic ation may possess and use prescribed medications when at scho ol, during school-sponsored activities, or before and after no rmal school activities, including school-sponsored child care o r afterschool programs and travel to and from any school-sponsore d activity. (g) Diabetes Care Tasks.

tivities, or before and after no rmal school activities, including school-sponsored child care o r afterschool programs and travel to and from any school-sponsore d activity. (g) Diabetes Care Tasks. Upon fulfilling the requir ements of Subsections (a), (b), and (c) of this Section, a st udent with diabetes shall be permitted to perform blood glucose checks, admi nister insulin through the insulin delivery system the stu dent uses, treat hypoglycemia, and otherwise attend to the care and management of his or her diabetes when at school, during school-s ponsored activities, or before and after normal school activ ities, including school-sponsored child care or afterschool programs . A student shall be permitted to possess on his or her person at al l times necessary supplies and equipment to perform these m onitoring and treatment functions. Upon request by the parent or student, the student shall have access to a private area for performing diabe tes care tasks. Any training of a school employee in di abetes care tasks shall be fully consistent with training programs and gui delines developed by the American Diabetes Association. § 9A302.

abe tes care tasks. Any training of a school employee in di abetes care tasks shall be fully consistent with training programs and gui delines developed by the American Diabetes Association. § 9A302. Administration of Medications by School Em ployees. (a) The Superintendent shall have at least one (1) school employee at each school who has met the requirement s of § 9A202 on duty during the entire school day, including any afterschool programs, to administer or assist with the administ ration of the following medications: (1) inhaled bronchodilator to a student with asthma as noted in the health care practitioner’s written sta tement under Subsection (c)(2) of this Section; (2) epinephrine auto-injector to a student with ast hma or a documented life-threatening allergy who is experi encing anaphylaxis or other conditions noted in the health care COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 9 practitioner’s written statement under Subsection ( c)(2) of this Section; (3) glucagon subcutaneously to a student with diabe tes who is experiencing hypoglycemia or other condition s noted in the health care practitioner’s written statement un der Subsection (c)(2) of this

3) glucagon subcutaneously to a student with diabe tes who is experiencing hypoglycemia or other condition s noted in the health care practitioner’s written statement un der Subsection (c)(2) of this Section; (4) insulin subcutaneously to a student, through th e insulin delivery method used by the student and at the times and under the conditions noted in the health care p ractitioner’s written statement under Subsection (c)(2) of this S ection; and (5) a seizure rescue medication approved by the Uni ted States Food and Drug Administration and any success or agency to a student with a seizure disorder who is experiencing a seizure or other condition noted in the health ca re practitioner’s written statement under Subsection ( c)(2) of this Section. (b) Training. For those assigned the duties under S ubsection (a) of this Section, training provided under § 9A20 2(a)(3) or (4) shall include instruction in administering the medicatio ns described under Subsection (a) of this Section, as well as re cognition of the signs and symptoms of the conditions associated wit h those medications and the appropriate steps to be taken t o respond to the symptoms of asthma, anaphylaxis,

ction, as well as re cognition of the signs and symptoms of the conditions associated wit h those medications and the appropriate steps to be taken t o respond to the symptoms of asthma, anaphylaxis, hypoglycemia and hyperglycemia, and seizures. (c) Required Written Statements. Prior to administe ring or assisting with the administration of any of the med ications listed under Subsection (a) of this Section to a student b y a school employee qualified under § 9A202(a), the student’s parent or guardian shall : (1) provide the school with a written authorization for the school employee to administer the medication at school; (2) provide a written statement from the student’s health care practitioner that the student has a condition requiring prescribed medication. The statement shall also contain the following information: COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 10 (A) the name and purpose of the medication; (B) the prescribed dosage; (C) the route of administration; (D) the frequency or precise times in which the medication may be administered; (E) the circumstances under which the medication may be administered; and (F) the length of time for which the

tration; (D) the frequency or precise times in which the medication may be administered; (E) the circumstances under which the medication may be administered; and (F) the length of time for which the medications ar e prescribed; and (3) provide the prescribed medication to the school in its unopened, sealed package with the label affixed by the dispensing pharmacy intact. (d) The statements required in Subsection (c) of th is Section shall be kept on file in the office of the school nurse or school administrator. (e) Limitation on Liability. (1) Disclosure. The Superintendent shall inform the parent or guardian of the student that the governme nt of Guam, the school, and its employees and agents shall incur no liability, except as provided in this Chapter, as a result of any injury sustained by the student resulting from acts or omissions related to the administration or the assistance in administration of any medication listed under Subsection (a) of th is Section or from any reaction to any of the medications listed under Subsection (a) of this Section that a parent or gua rdian has authorized the school to administer to a student, u nless the injury is the result of gross

action to any of the medications listed under Subsection (a) of this Section that a parent or gua rdian has authorized the school to administer to a student, u nless the injury is the result of gross negligence, willful o r criminal misconduct, or a conscious, flagrant indifference t o the rights or safety of the individual harmed on behalf of the school or its employees or agents. (2) Acknowledgment. The parent or guardian of the student shall sign a written statement acknowledging that the government of Guam and the school shall incur no liability, except as provided in this Chapter, and the parent or guardian COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 11 shall indemnify and hold harmless the government of Guam , the school, and its employees and agents against an y claims made for any injury sustained by the student result ing from acts or omissions related to the administration or the assistance in administration of any of the medications listed under Subsection (a) of this Section or from any reaction to any of the medications listed under Subsection (a) of this Section that a parent or guardian has authorized the school to a dminister to a student, unless

(a) of this Section or from any reaction to any of the medications listed under Subsection (a) of this Section that a parent or guardian has authorized the school to a dminister to a student, unless the injury is the result of gross negligence, willful or criminal misconduct, or a conscious, fla grant indifference to the rights or safety of the individ ual harmed on behalf of the school or its employees or agents. (f) Renewal. Permission for the administration of a ny of the medications listed under Subsection (a) of this Sec tion shall be effective for the school year in which it is grante d, and shall be renewed each following school year. (g) Expiration Dates. The school nurse or school administrator shall check the expiration date monthly for each medication listed under Subsection (a) of this Sect ion that is in the possession of the school. At least one (1) month pr ior to the expiration date of each medication, the school nurs e or school administrator shall inform the parent or guardian of the expiration date. (h) The requirements of Subsections (a) to (g) of t his Section shall apply only to a school that has, only to the exten t that it has, a student enrolled who has a

r guardian of the expiration date. (h) The requirements of Subsections (a) to (g) of t his Section shall apply only to a school that has, only to the exten t that it has, a student enrolled who has a condition requiring the prescribed medication listed under Subsection (a) of this Sect ion prescribed by the student’s health care practitioner. (i) Nothing in this Section shall be construed to require a school employee to consent to administer medication s to a student if the employee does not otherwise consent to provide the health service under § 9A202(a). (j) Notwithstanding any other provision of law to t he contrary: (1) the administration of any one or more of the medications listed under Subsection (a) of this Sec tion by COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 12 school employees shall not constitute the practice of nursing and shall be exempt from all applicable statutory and regulatory provisions that restrict the activities that may be delegated to or performed by a person who is not a licensed health care practitioner; and (2) a licensed health care practitioner may provide training to or supervise school employees in the ad ministration of any one

rformed by a person who is not a licensed health care practitioner; and (2) a licensed health care practitioner may provide training to or supervise school employees in the ad ministration of any one or more of the medications listed under Subsection (a) of this Section. --------- ARTICLE 4 SPECIFIC CONDITIONS § 9A401. Life-threatening Allergies. § 9A401. Life-threatening Allergies. (a) A student who has a documented life-threatening allergy shall have: (1) an epinephrine auto-injector provided by his or her parent or guardian in his or her possession or in t he possession of the school nurse, school administrator, or his o r her designee, in all school environments that the stude nt may be in, including, but not limited to, the classroom, the c afeteria, the school bus, and on field trips; and (2) a written individual health care plan in place for the prevention and proactive management for the student in all school environments that the student may be in, inc luding, but not limited to, the classroom, the cafeteria, the s chool bus, and on field trips. The individual health care plan req uired under this paragraph may be incorporated in the student’s individualized education

ted to, the classroom, the cafeteria, the s chool bus, and on field trips. The individual health care plan req uired under this paragraph may be incorporated in the student’s individualized education program required under Pub lic Law 94-142, or the student’s 504 plan required under Pu blic Law 93-112. (b) Each school is encouraged to keep an epinephrin e auto- injector in a minimum of two (2) locations in the s chool, including, COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 13 but not limited to, the school office and the schoo l cafeteria, so that epinephrine may be administered to any student beli eved to be having a life-threatening allergic or anaphylactic reaction. Schools electing to keep epinephrine auto-injectors shall maintain them in a secure, accessible, but unlocked location. The prov isions of this Subsection shall apply to the extent that the epinephrine auto- injectors are donated to a school, or a school has sufficient funding to purchase the epinephrine auto-injectors. (c) Policies and Procedures. Each school electing t o keep epinephrine auto-injectors shall implement policies and procedures for managing a student’s life-threatening allergic or

ine auto-injectors. (c) Policies and Procedures. Each school electing t o keep epinephrine auto-injectors shall implement policies and procedures for managing a student’s life-threatening allergic or anaphylactic reaction developed and approved by the Guam Educati on Board. --------- ARTICLE 5 RIGHTS OF STUDENT AND PARENTS § 9A501. Right of Equal Access. § 9A502. Prohibition on Parental Requirements. § 9A501. Right of Equal Access. The Superintendent shall permit a student who has a condition requiring prescribed medication to attend the same school the student would attend if the student did not have th e condition. Such a student may only be transferred to a different sc hool based on health care needs if the individualized education p rogram team, the Section 504 team, or, if appropriate, the student’s health services team, makes the determination that the student’s he alth condition requires that the student’s care be provided by a l icensed health care practitioner at a different school. For the purpose of this determination, the teams shall include the parent or guardian. The parent or guardian may invite the student’s treatin g physician to the team meeting and the team

ent school. For the purpose of this determination, the teams shall include the parent or guardian. The parent or guardian may invite the student’s treatin g physician to the team meeting and the team shall consider the physician’s input, whether in person or in written form, when making t his determination. This determination shall be based on individualized factors related to the student’s health conditions. The Superintendent shall not prohibit a student who has a condition COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 14 requiring prescribed medication from attending any school on the sole basis that: (a) the student has a condition requiring prescribe d medication; (b) the school does not have a full-time school nur se; or (c) the school does not have school employees who a re trained in accordance with § 9A202 and assigned to provide care. § 9A502. Prohibition on Parental Requirements . Parents or guardians of a student who has a conditi on requiring prescribed medication shall not be required or pressured to provide care for the student during regular school hours or during school- related activities in which the student is a partic ipant.

iring prescribed medication shall not be required or pressured to provide care for the student during regular school hours or during school- related activities in which the student is a partic ipant. For the purposes of this Section, a participant is not a st udent who merely observes the school-related activity. --------- COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 15 COL117201817 GCA EDUCATION CH. 9A STUDENT HEALTH SERVICES ACT 16 COL1172018