SD5 - Report on the Needs of Medically Fragile Students

  • Published: 1995
  • Author: Department of Education and Department of Health
  • Enabling Authority: Senate Joint Resolution 306 (Regular Session, 1993)

Executive Summary:
During its 1993 legislative session, the Virginia General Assembly adopted a joint resolution (SJR 306) requesting that the Department of Education, in conjunction with the Department of Health, study the needs of medically fragile children in Virginia. The request was initiated in response to several concerns brought to the attention of members of the General Assembly.

First, several children, considered to be medically fragile, had been placed in a nursing home outside of their parents' city or county of residence. The nursing home staff attempted to enroll several of these children in the school division of the county where the nursing home was located. These children were denied admission because their legal residency remained in the city/county of their parents' residence. Consequently, the school division where the nursing home was located was under no legal obligation to provide educational services to these children.

Second, anecdotal evidence and limited research indicated an increased enrollment of children with chronic illnesses and ongoing medical needs in the public schools of the Commonwealth. The types of services, the service providers, the training of the service providers and the policies related to the provision of medical or health services varied greatly from school division to school division throughout the Commonwealth. Concerns were raised regarding the adequacy of the services, the appropriateness of teachers, paraprofessionals, school nurses and administrators conducting some of the medical or health procedures, and the lack of training for those persons conducting these procedures.

SJR 306 specifically set out nine objectives for the study, requesting the Departments of Education and Health to:

"(i) identify and determine the number of medically fragile children in Virginia,

(ii) determine which of them are citizens of the Commonwealth and their place of residence,

(iii) determine the nature and seventy of their disabilities and treatment needs,

(iv) determine the number of medically fragile students being served In the public schools and the nature and seventy of their disabilities,

(v) identify the types of health maintenance and treatment procedures and the types of staff persons necessary to conduct these procedures,

(vi) determine the responsibility of public schools to provide such health maintenance and the types of staff persons necessary to conduct these procedures,

(vii) determine the impact on and liability of those responsible for providing such services to students,

(viii) determine the level of guidance given by the local school boards to staff regarding the provision of health services to students, and

(ix) the level of interagency collaboration to determine the need for policy and regulatory changes to improve the delivery of educational, social, health, and medical services to such children."

In addition to SJR 306, the 1993 General Assembly considered two bills, Senate Bill 720 and House Bill 2188, which would have required registered nurses be employed by each school division in the Commonwealth. This legislation was defeated. However, the Senate Education and Health Committee requested the Board of Education to study how funds for health services are used In each school division and report this Information to them. The Department of Education incorporated this study of funding into the study requested In SJR 306, and these findings are included as Appendix A.

Because of the complexity of issues and the interagency nature of service delivery to medically fragile children, the study team was composed of staff from the Departments of Education, Health, and Mental Health, Mental Retardation and Substance Abuse Services. Critical team members represented various advocacy organizations and service providers. Several team members and reviewers contributed essential legal and medical knowledge relevant to the needs of medically fragile children The Interagency team was responsible for Identifying and researching various issues, developing consensus on the scope of the study, formulating recommendations to resolve identified problems and drafting a written report.

The study team developed and administered a comprehensive survey of public schools to profile medically fragile students and obtain other data as requested In the resolution. Information was also obtained from various sources on the number of medically fragile children receiving services in settings other than public schools.

Recommendations of the study team are listed below:

1. School divisions should develop a "health service plan" for each student who is a medically fragile child as defined by this study.

2. Local school divisions should develop policies that address the provision of services to students who are medically fragile to include staff selection and training, roles and responsibilities.

3. Local school divisions should develop policies to address the emergency medical needs of students, including those who are medically fragile.

4. The local Health Advisory Board, required by § 22 1-275 1 of the Code of Virginia, should take an active role in assigning school divisions in developing policies related to children who are medically fragile.

5. School divisions should provide periodic in-service or opportunities for school staff to attend programs to increase staff awareness and understanding of the general health issues faced by schools and the needs of medically fragile students, specifically.

6. For risk management purposes, school divisions should document the health services provided to any medically fragile or other students.

7. Nursing homes in the Commonwealth that elect to establish pediatric units should be licensed under both Chapter 5 of Title 32.1 of the Code of Virginia and under Chapter 10 of Title 63.1 of the Code.

8. School divisions should review and evaluate their policies and procedures relative to Section 504 of the Rehabilitation Act of 1973.

9. The Department of Education, in conjunction with the Attorney General's Office, should review and evaluate the need for legislation establishing statutory immunity for school personnel performing acts within the scope of their employment while providing health-related services to the medically fragile population.

10. The Department of Education, in collaboration with the Department of Health, should develop and update procedural guidelines.

11. The General Assembly may wish to consider further study, focusing on the needs of families with medically fragile children.