Background Information and Guidance
Legal Rights of Students with Diabetes
(James A. Rapp, JD, et al.) (Mar. 2015)
A comprehensive guide for advocates and attorneys on the legal rights of students with diabetes. It contains information on the law, strategies for securing these rights, procedures for resolving disputes, forms and other resources.
Legal Protections for Students with Diabetes
A brief introduction to the three federal laws (Section 504, the ADA, and the IDEA) that provide legal protection to students.
"Education Law" (PDF)
(James A. Rapp, JD) (May 2008)
Excerpt from a treatise on all aspects of education law which addresses the obligations of schools under federal law to provide care and services to students with diabetes.
School Services for Students with Diabetes under IDEA and Section 504: Choosing the Right Statute for Coverage (PDF)
(Victoria Thomas, JD – American Diabetes Association) (July 2009)
This memorandum explains the key differences between the two main federal statutes that offer a right to services in public elementary and secondary schools to students with diabetes, and explains some advantages and disadvantages of coverage under each. It is designed to help attorneys and advocates determine whether to seek coverage under the IDEA or Section 504 for a particular student.
The Occupational Safety and Health Act and Bloodborne Pathogens Standard: Application to Diabetes Care Tasks at School and in Employment (PDF)
(Victoria Thomas, JD – American Diabetes Association) (June 2008)
This memorandum describes the Occupational Safety and Health Act (OSHA) as it is relevant to diabetes care at work and school, specifically explaining that OSHA generally does not present barriers to performing diabetes care tasks anywhere, anytime at most workplaces and most areas in schools.
Helping the Student with Diabetes Succeed: A Guide for School Personnel
(American Diabetes Association, 2022)
Designed to educate school personnel about the needs and rights of students with diabetes. It includes information on diabetes and its proper care at school, as well as sample forms, and other resources.
Diabetes Care in the School Setting
Diabetes Care Volume 38, Supplement 10 (Oct. 2015)
This official position statement expresses the Association’s views on what diabetes care is needed and appropriate at school.
Sample Plans
The Association has drafted a sample Section 504 plan and a sample Diabetes Medical Management Plan, which are key documents setting out what services are to be provided to a particular student.
Going to College with Diabetes: A Self Advocacy Guide for Students
(Katharine Gordon, JD; James A. Rapp, JD; Brian L. Dimmick, JD; Crystal Jackson) (April 2011)
A self-advocacy tool for students in a postsecondary setting, including: information on students’ legal rights and postsecondary institutions' legal obligations; strategies for obtaining reasonable modifications and accommodations; tips to help students manage their diabetes in a new environment; sample forms; and legal information for when a formal complaint or legal action may become necessary.
Administrative Rulings
Inadequate Provision of Services/Accommodations
- Northport Public School District, 116 LRP 31017 (Mich. July 20, 2016) (Case involving child with autism spectrum disorder and type 1 diabetes who raised claims related to special education for autism and related services for diabetes. Where the student's medical care plan didn't require it to test her blood glucose in a specific location or provide her an environment free of candy, and a teacher's single testing error was an isolated incident, there was no failure to follow the care plan).
Diabetes and the IDEA
- In re: Student with a Disability, 115 LRP 50968 (SD July 18, 2014) (where student’s diabetes accommodations were incorporated into an IEP and diabetes had a significant effect on student’s behavioral disability, the District violated the IDEA when it modified the IEP regarding blood sugar level testing without considering the diabetes management plan or consulting medical providers).
- Clark County School District, 114 LRP 45477 (Nev. Aug. 28, 2014) (parents’ repeated statements to school employees’ regarding inadequate care of student’s diabetes and their belief that such inadequate care was affecting his educational performance did not trigger the school’s Child Find obligations under IDEA because parents’ concerns would have been rectified by appropriate diabetes care—nothing in parents’ requests indicated that special education was necessary).
- Bryant School District, 69 IDELR 198 (Ark. Dec. 23, 2016) (student’s “constant monitoring and frequent treatment” for her diabetes did not impact her educational performance, and thus an IEP was not necessary to provide FAPE. Since parents did not request an evaluation, and her educational performance did not appear to be diminished, district did not violate IDEA).
Refusal to Provide Required Services
- Tunkhannock Area School District, 115 LRP 36528 (Pa. June 11, 2015) (ruling that A Pennsylvania district’s refusal to let anyone other than the school nurse administer glucagon to a second grader with diabetes resulted in disability discrimination under Section 504 of the Rehabilitation Act, regardless of whether state law permits a trained, unlicensed staff member to administer it) (“There is no minimal acceptable level of exclusion from school on the basis of disability.”)
Key OCR Agreements
The U.S. Department of Education’s Office for Civil Rights is responsible for enforcing the rights of students with disabilities under Section 504 of the Rehabilitation Act and the Americans with Disabilities Act. Below are several OCR decisions and settlements addressing students with diabetes.
Failure to Implement a 504 Plan
- West Genesee (NY) Central School District (2015) (PDF) (district's failure to deliver a student's diabetes plan to his bus drivers at the beginning of the year constituted a Section 504 violation. The sixth-grader's 504 plan required that all staff review his care plans when the school year began, but no one had done so with his bus drivers or informed them of the student's condition. OCR observed that the district reviewed policies and procedures with drivers twice a year, but this didn't include a review of students' specific plans).
- Lincoln Preparatory Academy (AZ) (2016) (PDF) (OCR finding of failure to implement student’s 504 Plan and failure to evaluate where transfer student provided existing 504 plan during his May enrollment, but school did not acknowledge Plan until mid-December. School’s implementation of a medical management plan did not excuse failure to implement a 504 Plan, as the medical management plan did not contain several of the accommodations laid out in the 504 Plan).
- North East (TX) Independent School District (2016) (PDF) (failure to individually assess whether a student should be permitted to carry blood glucose testing supplies, despite school policy requiring all medication be kept in the nurse’s office, constituted a violation of the district’s obligations under the ADA and Section 504).
Finding of Discrimination
- Irvine Unified School District (1995) (PDF) (explaining OCR’s interpretation of 34 C.F.R. 104.4(b)(1)(v) which prohibits recipients of federal funding from providing “significant assistance” to entities that discriminate on the basis of disability, which here, was an after-school program)
- Park City (UT) School District (2016) (PDF) (OCR ruled that the district violated Section 504 when it asked parents of children with diabetes to attend field trips, because it did not do so for students without disabilities. District’s explanation that it only did so when nurses weren’t available was not a legitimate excuse).
Failure to Evaluate
- Hesperia (CA) Unified School District (2015) (PDF) (OCR finding of noncompliance where parent requested evaluation due to student’s ADHD and diabetes and district denied services based on an evaluation of his ADHD alone. Student’s numerous nurse visits for diabetes were sufficient to cause the school to evaluate the student for special education and related services to address his diabetes).
Denial of FAPE
- Sarasota County (FL) School District (2012) (PDF) (OCR determined that a district violated a student’s right to receive a FAPE when it required that the parent come to school to administer the student’s diabetes care).
Service Animals
- Cullman County (AL) Schools (2017) (applying the Title II service animal regulations, 28 C.F.R. § 35.104, as well as Section 504, OCR found that a district that refused to allow a student to travel with his service animal on the school bus without certain documentation violated the ADA and Section 504).
ADA’s Litigation
M.F., et al. v. New York City Department of Education
In 2018, the Association joined with three families to bring a class action lawsuit concerning the provision of diabetes care and access to accommodations and related services in New York City public schools. For more information concerning the case and its status in litigation click here.
K.C., et al. v. O'Connell, et al. and American Nurses Association, et al., v. Torlakson, et al.
In 2007, the Association settled a lawsuit against the California Department of Education and two school districts regarding diabetes care in California public schools. The settlement included a Legal Advisory designed to inform school districts of their legal obligations to serve students with diabetes. After the settlement, several nursing organizations filed suit to challenge provisions of the Legal Advisory relating to who may administer insulin to students. The California Supreme Court sided with the ADA and ruled that California law permits trained, unlicensed personnel to administer insulin. Click on the links below to learn more about the settlement and litigation regarding diabetes care in California schools.
Significant Cases
B.A.T.M. v. School Board of Pinellas County
In a Florida state administrative hearing, parents of a child with type 1 diabetes challenged a school district policy requiring their child to be transferred to a different school where there was a full time school nurse, despite state law that permits school districts to train unlicensed school personnel to administer insulin and other diabetes care to children. A state hearing officer ruled that the district’s policy violates Section 504 because it does not provide for individualized assessment of the needs of the child.
• Hearing Officer Decision (Oct. 2011) (PDF)
R.K. v. Board of Education of Scott County, 494 Fed. Appx. 589 (6th Cir. 2012)
This case challenges a Kentucky school district’s policy requiring a student with type 1 diabetes who is not yet able to self-administer to transfer to another school that has a full-time nurse, rather than being able to receive needed care at the school he would otherwise attend. The Sixth Circuit reversed the district court's grant of summary judgment to the school district.
• Amicus Brief of American Diabetes Association (June 2011) (PDF)
• Amicus Brief of U.S. Department of Justice (June 2011) (PDF)
• Sixth Circuit Opinion (August 2012) (PDF)
CTL v. Ashland Sch. Dist., 743 F.3d 524 (7th Cir. 2014)
In this case, parents filed suit challenging the school’s failure to implement their child’s 504 Plan’s requirement that there be 2 trained diabetes personnel as back-ups to the school nurse. The Seventh Circuit affirmed the District Court’s grant of summary judgment to the school district. In so doing, the Court explained that for 504 plan violations to constitute disability discrimination, they must be significant enough to effectively deny a disabled child the benefit of a public education. The school district's failure to train two additional staff members was at most a minor violation of the 504 plan and thus did not deny him the benefit of a public education.
Additional Miscellaneous Materials
Representing Families of Children with Diabetes Facing Child Abuse and Neglect Investigations (PDF)
Carolina Caicedo, Director, Legal Advocacy, Government Affairs and Advocacy (March 2017)
A resource for attorneys to gain a basic understanding of child protective services agencies and their processes for conducting investigations including a discussion of strategies and case law to consider when child abuse and neglect reports are made in bad faith.
