Opinion ID: 1038649
Heading Depth: 3
Heading Rank: 1

Heading: “[A]s allowed by law.”

Text: In permitting school personnel other than licensed health care providers to administer medication, sections 601 and 604 of title 5 qualify that permission with language deferring to other laws governing the subject. Specifically, section 604 provides that “[o]ther designated school personnel may administer medication to 10 pupils . . . as allowed by law.” (Id., subd. (a), italics added.) Similarly, section 601 limits such “ „[o]ther designated school personnel‟ ” to those who “[m]ay legally administer the medication to the pupil . . . .” (Id., subd. (e)(2), italics added.) The Nurses contend the italicized language means that only those school personnel who are licensed health care providers, such as registered nurses, may administer medications, and that unlicensed personnel may assist but not actually administer medications. By way of illustration, the Nurses assert that unlicensed school personnel “are permitted to open a bottle of cough syrup and pour the prescribed dose but cannot pour it down the student‟s throat,” or they may monitor a diabetic student‟s glucose levels and determine the correct dosage of insulin but may not administer the drug by giving the injection or pushing the button on an insulin pump. The Nurses have misinterpreted the regulations. Before explaining that conclusion, however, and in order to clarify the scope of our holding, we note that one significant premise of the Nurses‟ argument is correct: There is no reason to believe the Legislature intended to delegate to the Board, a state educational agency charged with governing the public schools (see §§ 33000, 33031), any authority to override statutes in which the Legislature has required specific licensure before a person may perform a health care function. We assume the Board shares this understanding. In section 610 of title 5, the Board explains that “[n]othing in this article may be interpreted as . . . affecting in any way: [¶] (a) The statutes, regulations, or standards of practice governing any health care professional licensed by the State of California in the carrying out of activities authorized by the license . . . .” Viewed in this light, the language in the Board‟s regulations that qualifies the authority of unlicensed school personnel to administer medications — “as allowed by law” (tit. 5, § 604, subd. (a); see also id., § 601, subd. (e)(2)) — is reasonably and appropriately interpreted as reflecting 11 the Board‟s deference to laws articulating policy choices that lie beyond the scope of its delegated authority over the state‟s public schools. This does not mean, however, that only licensed health care professionals may administer prescription medications in public schools. It means, rather, only that the Board‟s regulations do not authorize unlicensed school personnel to administer such medications in violation of other applicable laws or regulations. To illustrate, only licensed health care providers may administer controlled substances. (See Health & Saf. Code, § 11154, subd. (a).) Also, the Legislature has mandated specific training before unlicensed school personnel may administer three specially regulated emergency medications to students. (See §§ 49414 [epinephrine auto-injectors for anaphylaxis], 49414.5 [glucagon for severe hypoglycemia] and 49414.7 [antiseizure medication for epilepsy].) A school employee without the licensure or training required by statute for such medications would not be “allowed by law” (tit. 5, § 604, subd. (a)) to administer them and, thus, not permitted to do so solely by force of the Board‟s regulations. Compliance with those other laws would also be necessary. In contrast, no such law prohibits unlicensed persons from administering prescription medications generally, or insulin in particular, in carrying out the medical orders of licensed physicians. The Nurses attempt to find such a rule in the Nursing Practice Act (Bus. & Prof. Code, § 2700 et seq.) (NPA), which defines the practice of nursing to include a list of patient care functions including “the administration of medications” (id., § 2725, subd. (b)(2)), and prohibits the unauthorized practice of nursing (id., § 2732). In opposition, the Association contends the listed functions fall within the definition of nursing practice only under circumstances where they “require a substantial amount of scientific knowledge or technical skill.” (id., § 2725, subd. (b) [“The practice of nursing within the meaning of this chapter means those functions, including basic health 12 care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including all of the following: . . .” (italics added).].) The routine administration of insulin outside of hospitals and clinical settings, the Association observes, does not require substantial scientific knowledge or technical skill and is, in fact, typically accomplished by the patients themselves, including some children, or by friends and family members. We need not speak to the definition of nursing practice in order to resolve this case. However broadly the NPA may define the practice of nursing, and whatever the NPA may correlatively prohibit as unauthorized practice, the NPA expressly exempts from that prohibition “[t]he performance by any person of such duties as required in . . . carrying out medical orders prescribed by a licensed physician . . . .” (Bus. & Prof. Code, § 2727, subd. (e).) This medical-orders exception, as we shall explain, is broad enough to cover unlicensed school personnel who act as volunteers for specific students, at their parents‟ request, to carry out physicians‟ medical orders in accordance with section 49423 and its implementing regulations.