The plight of a diabetic five-year-old boy has illustrated how poor policy management in schools could lead to potential dangers for students.

On the same day that The Age published an article accusing the Victoria Department of Education and Early Childhood Development (Department) of failing in its duty of care owed to children with diabetes, the Department has changed its policy on diabetes management. The new policy now makes it clear that insulin can be administered by a teacher with proper training, which clarifies the earlier ambiguous policy.

Diabetes is a condition where a person's body is unable to produce insulin which is required to regulate blood sugar. It is managed by blood sugar testing, managing diet, and administering insulin by injection or infusion.

The case of the Boyers

The trigger for The Age article was the plight of the Boyer family, whose five-year-old son is diabetic. According to the article, his condition requires that his blood sugar levels and insulin doses be monitored constantly, with blood sugar level tests conducted every two hours.

While he was in kindergarten, the Department permanently funded a nurse for him. Subsequently, the family is said to have been told that a qualified medical aide would not be provided when he started primary school in 2015.

The family sought legal help, which was provided pro-bono (free of charge) by law firm Arnold Bloch Leibler (ABL). The legal advice was that the Department was not compliant with current laws in failing to accommodate his condition.

Ms Boyer, the boy's mother, said to The Age that the department agreed to provide a nurse for six months, leaving the family with some uncertainty as to the future beyond that.

The Department's old policy

Until last week (on 10 October 2014), the Department policy on diabetes stated that 'teachers are under no obligation to administer insulin or glucagon'. Peter Siedel, of ABL, is quoted by The Age as saying that 'there are potentially catastrophic consequences that could arise from the misleading nature of the [Department] policy'. He also said that the Department policy did not make it clear that it was illegal for teachers without appropriate qualifications to administer insulin or glucagon.

Issues for school staff

The case of the Boyers' son throws up two distinct issues.

Firstly, the ever-present student duty of care applies, as it always does. The extent of the student duty of care depends on the particular circumstances. In relation to a child with diabetes, the student duty of care obliges schools to take reasonable actions to guard against the possibility of harm arising from a student's condition. In the case of the Boyers, this necessarily involved the provision of a health professional to assist the child. For other students, the management of diabetes usually involves the provision of a health management plan, which brings together a child's parents, health professionals, teachers and school administrators to manage the risks of diabetes. This health management plan would include any necessary adjustments.

The second issue for schools is the requirement to accommodate students with disabilities. Under the Disability Standards for Education 2005 (Cth), non-government schools across Australia have a legislative obligation to make 'reasonable adjustments' for students with disabilities so that they may participate in education 'on the same basis' as other students.  A 'reasonable adjustment' depends on the circumstances. In the case of the Boyers, it was contended by ABL that the Department was not meeting its obligation in failing to provide medically qualified support.

The Department's new policy

In contrast to its previous policy, the Department's new policy states that 'additional support by educators and support staff may be necessary', and that 'Principals must make reasonable adjustments for students with diabetes'. These adjustments are stated to include:

• staff training based on individual student needs;
• ensuring staff have appropriate diabetes education including:
  • general training for all staff;
  • specific training for staff closely involved with diabetic students; and
  • targeted support for younger students.

The new policy also states that 'students who require assistance to administer their insulin can receive this support from a nominated school staff member who has received appropriate training in the administration of insulin'.

Policy on the run?

The timing of the article by The Age – and the simultaneous update to the Department’s policy – may give rise to the inference that the policy was updated in response to the Boyers’ case.

When School Governance contacted the Department to find out if this was the case a Department spokesman said ‘the Department has been reviewing its diabetes policy for several months in consultation with leading health organisations and, following the completion of the review, uploaded the revisions to the online policy guide’.

Whilst the Department’s review of the policy may or may not have been driven by the Boyer’s case in our experience, there is however often a direct relationship between the ‘thickness’ of a school’s policy with respect to a particular issue, together with the legalese in which it is written, and the severity of a recent incident that has occurred at the school. ‘Policy on the run’ is symptomatic of a reactive approach to policy management in schools.

Good governance dictates that schools identify potential student safety risks (and the management of diabetes is clearly one of them) and take steps to proactively manage these risks.  Proactive management generally requires the drafting of plain English policies and the provision of training to staff who are expected to manage the policy directive.