Letter To Board Members Regarding the Self-Administered Medications Policy

The following is a letter I sent to ASD board members on March 18, 2014 regarding the updated policy they were presented for self-administering medications:

Dear Board Members-                                                                                                                               

I appreciate your willingness to examine and update your policy regarding Epi-pens and other life-saving medications.  I do have some concerns that I would like to share with you before the board makes a final decision on the updated policy that has been presented.  I understand that you consulted your attorneys as well as the Utah County Health Department in updating this policy.  I do believe that not including parents was a mistake.  While I appreciate and value the input of these professionals, parents of children who are living with life-threatening conditions have important and essential insight as to how to treat these conditions.

My first concern is with 1.1.6 that states that “a district employee may not administer hypodermic syringe injections or “shots” without express written permission of the Director of Student Services.”  I am concerned that this policy would prevent teachers and other ASD employees from administering life-saving epinephrine should my daughter go into anaphylactic shock and be unable to self-administer her medication. 

I also see potential problems with 2.4, 3.4, and 4.4.  The new policy eliminates parents from having a say in how and where their child’s life-saving medication is stored.  While I appreciate the valuable work that administrators and nurses provide, placing this decision solely in their hands can lead to major problems.  A high school principal may have 2,500 students and school nurses in Utah are one for every 4, 952 students.  To assume that these individuals will fully comprehend the needs of students with life-threatening conditions is incorrect.  I believe that the decision about where and how life-saving medication can be stored should be done “in consultation with parents.” 

I know my child best.  I know what it looks like when she goes into anaphylaxis.  Every time my daughter has ingested a tree nut, she has gone into anaphylactic shock.  I have a friend whose daughter has a peanut allergy.  Her allergy has been treated successfully with Benadryl.  But an administrator or school nurse may not understand the ways our two daughters should be treated differently.  The other issue associated with this is that as a parent, whenever I have signed a field trip permission form for my daughter, I have always written at the bottom, “Please remember to bring her Epi-pen.” An administrator or school nurse may not remember this, but I always do.  Storing these medications in the nurse’s office may seem like a simple solution, but the situation is more complicated than that.

We have actually encountered problems more than once when we have turned in Epi-pens to schools.  Twice when I have gone to retrieve the Epi-pen on the last day of school, the medication has been missing.  One was found at the beginning of the following school year, but the other was never recovered.  While a missing Epi-pen has been an annoyance since they are so expensive, it could have been the difference between life and death if my daughter had gone into anaphylaxis.  We have always provided elementary school teachers with an Epi-pen to be kept in the classroom as well.  I have never had a teacher misplace my daughter’s life-saving medication.  Humans err.  I feel it is better for a teacher to keep this medication in her classroom than in a nurse’s office.  Time is of the essence in treating medical emergencies and precious moments can be lost figuring out who has the key to the medication box in the nurse’s office.  A teacher who has one or 2 children in an elementary class with life-threatening issues will be more likely to keep track of these medications than a nurse who may not know the child.

The other policy I see as having potential problems is 3.6 where it states that “no student is permitted to sell, share, or otherwise give to others any medication, prescription or non prescription.”  Epinephrine does not give you a “high,” it is simply adrenaline.  But it can mean the difference between life and death.  The way I read the policy is that if my daughter has a friend having an anaphylactic reaction and her friend does not have her Epi-pen, my daughter is violating the district’s drug policy if she chooses to give her Epi-pen to her friend and save her life.  Epi-pens only come in 2 doses-Jr. and Adult.  While this may seem like an unlikely situation, with 1 in 13 children being diagnosed with food allergies, it is all too possible that during my daughter’s school career, she may witness another student having an anaphylactic reaction and be in a position to assist.  Epi-pens actually come in a twinpack because if the anaphylaxis symptoms have not started subsiding within 15 minutes, another Epi-pen must be administered.  It is very possible that a child would have an Epi-pen and need another Epi-pen injection, but not have a second pen.  In my experience, children with life-threatening conditions generally have a higher level of maturity than their peers.  They are all too aware of their own mortality.  I am not suggesting that students should be given a free-for-all to trade out and share medications, but I also think there is a basic common sense that in life-threatening situations, there should be exceptions.

My last concern is about policy 3.2 which states that the parent “authorizes the student to have and use the epinephrine auto-injector while acknowledging that the student is responsible for and capable of self-administering the medication.”  I want to clarify that while my student is fully capable of self-administering her Epi-pen, anaphylaxis means that her airway shuts down and she can pass out, rendering her unable to self-administer her Epi-pen.  With her being “responsible” for self-administering, I want to make sure that if she becomes unable to administer her medication, that it does not relieve the school of the responsibility of injecting her.

I appreciate your time and your willingness to hear my concerns so that we can all work together to keep the children of ASD safe.

Julie King