January 22, 2013
Dear Ms. Sandals and Mr. Valeriote,
I am contacting you today as a parent of a 7 year old boy, Owen,
recently diagnosed with Type 1 Diabetes. He was attending Victory
Public School until he went into the hospital in December. He is ready
to return to his friends and teachers, but there is a problem. The
injection of Glucagon, a life-saving measure necessary for severe
blood sugar lows, is not currently permitted to be administered by the
public school teachers in Guelph. Superintendant of Education, Brent
McDonald, plans to discuss the Public School Board emergency protocol
with a few of the authors of the policy this week, and perhaps we will
be closer to allowing Glucagon to be administered to students by
teachers at the public schools in Guelph. The Wellington Catholic
School Board recently adopted this protocol and Catholic School
students with T1D may now receive Glucagon at the schools in a life
threatening emergency. They have set an important precedent that was 2
and a half years in the making. The rest, theoretically, should be
easy for the other school boards to follow.
As a family we were thrilled that Victory's principal, teachers, after
school teachers and parent volunteers rallied for Owen and learned
about juvenile diabetes with our diabetes nurse over a lunch hour.
Owen's teachers met with my spouse and I to discuss the finer details
of his care, i.e. Owen's daily meal, snack, insulin and exercise
schedule. We discussed Owen's requirements for low or high blood sugar
levels, whether he would eat 15 g of carbohydrates for high blood
sugar or sit out an athletic event in favour of a quieter activity
when his blood sugar is a little high.
Similarly, we reviewed the emergency protocol in the event that Owen
required emergency procedures for life threatening symptoms of low
blood sugar when consuming carbohydrates in the form of orange juice
or Dex4 tabs by mouth is impossible. The treatment for
unresponsiveness in a child with T1D is an injection of Glucagon - a
hormone that is produced by the liver to release glucose into the
blood stream, thereby preventing seizure, coma and death.
The method for this procedure is to use a syringe of sterile water
that the kit provides and inject the water into a vial of Glucagon
powder, mix gently and withdraw the solution into the syringe and
simply inject the child subcutaneously, not intravenously, anywhere
there is a bit of padding. The importance of the response time cannot
be overstated in the event of a rapid crash and ensuing risk of life
that children with juvenile diabetes endure - every second counts.
Timing is crucial in the event of anaphylaxis as demonstrated by the
death of Sabrina Shannon, the namesake of Sabrina's Law (Bill 3),
passed in 2006. The concept behind epinephrine autoinjectors
(EpiPens) is very similar to the life saving Glucagon injection. I
spoke with mothers of children with T1D today and they have met the
challenge of Glucagon protocols in their children's schools through
similar means. One mother volunteered around the clock at her son's
school so that she would not let him out of her sight, "Velcro'd
together" was her term for how close they are at school. Another
mother also spent so much time at her daughter's school that the
teachers privately agreed to inject her daughter should the need
arise, despite protocols to the contrary. Fortunately, neither mother
ever had an occasion to use the Glucagon. The life and death scenarios
that could develop for students with T1D shouldn't be left to the
mercy of empathetic teachers. We should formalize the protocol and
pass a law that clearly outlines the responsibility of the schools -
all Guelph, Ontario and every province and territory in Canada's
schools to allow teachers to inject Glucagon to save the lives of
Canadian T1D students.
When I discovered this gap in the emergency protocol policy, I was
told that T1D parents are trying to have a law passed in favour of
teachers injecting Glucagon, but nobody wants their child's name on
this law. I couldn't agree more.
Please contact me to share your thoughts on the next steps to be taken.
Best regards,
Beth Mulkins
January 29, 2013
Dear Ms Mulkins
Thank you for your email to MPP Liz Sandals.
We are currently looking into the matter with the Ministry of Education
and the Upper Grand DSB.
We will get back to you as soon as we have received responses to our
inquiries.
Sincerely
Jenny
Jenny Waterston
Constituency Assistant for
Liz Sandals, MPP
Guelph
February 13th, 2013
Dear Ms.Sandals and Mr. Valeriote,
I appreciate the Ministry’s effort to investigate a change in the
Glucagon policy at the Upper Grand Public School Board to match the
updated policy at the Wellington Catholic School Board. I was so
touched that the Victory Public School teachers spent their lunch hour
on January 14th learning with our diabetes team nurse so that they
would know what to be watchful for when Owen (at this point the only
T1D student) was on the playground. I accompanied my son last week to
school to test his blood sugar before and after exercise to gain a
clearer understanding of his blood sugar rhythms during the school day
and to administer insulin at lunch. I was willing to join my son at
school while we were waiting for the Victory Kids' Club board of
directors to meet last Thursday to discuss the administering of
Glucagon by their staff to my son in a low blood sugar emergency.
The board president contacted me the other day to communicate the
board's response to our request to train their staff to use Glucagon
in the unlikely event that it may be necessary. The president told me
that there was concern among members of the board regarding liability
if the Glucagon was not administered properly. He also communicated
that the board was researching further whether or not as tenants of
the Upper Grand District School Board, that they would be permitted to
have their after school staff administer Glucagon.
What in the world is that about? What manner of insane pettyfoggery is
this? We have descended into the utterly absurd. Where is everyone’s
humanity? I have my emergency first aid certificate and go out of my
way to help strangers. I am deeply disappointed by the unprofessional,
inhumane behaviour that I am observing in my community school and
associated boards. I have no doubt that given the opportunity, one or
more of Owen’s kind teachers would have offered to intercede if the
situation demanded, but a pre-emptive strike by overzealous and
parsimonious policy pushers thwarted honest intentions.
As a parent who is witnessing Upper Grand District School Board
administration needlessly protect their careers, actively advising
teachers to not administer Glucagon should the unlikely need arise and
now actually digging for reasons to refuse us related only to a rental
agreement, I am beyond incredulous. Meanwhile, my son is making a
hugely rocky start to his life with type 1 diabetes because he will
always associate his diagnosis with this yawning void, the sudden
withdrawal from school that was unrelated to his newly regained health
and more importantly - educators taking a step sideways rather than
doing the right thing.
There is simply no risk to a person administering Glucagon just as
there is no risk to the Type 1 diabetic child who is unconscious and
close to coma or death - there is only help and revival in this one
small action. Imagine denying an inhaler to an asthmatic student or an
EpiPen to an anaphylactic child? I don't know how I am going to remedy
this with Owen - how am I going to explain that adults are more
concerned about something that seems uncharacteristic of Canadians -
to be concerned about lawsuits and their careers rather than giving a
simple life-saving subcutaneous injection to a student? In each and
every case of type 1 diabetic students attending public schools in the
Guelph and Kitchener-Waterloo area that I know of, there is a person
on the school premises willing to administer the hormone despite the
"risk" to their career. Teachers have been actively advised not to do
so at Victory Public School.
In other instances, in other schools, I doubt very much that teachers
were advised not to administer Glucagon. I believe that the situation
was simply left to let cooler heads prevail and allow the entire
matter to be considered in perspective, i.e. it is highly unlikely
that this small service should ever be asked of anybody, but it gives
peace of mind to know that if necessary, this small inconvenience
would have hugely beneficial consequences for the T1D student and
their family.
I would be an irresponsible parent to consider sending Owen to school
where there is nobody to step in if necessary. My last hope was that
the after school teachers would be on the premises and able to respond
if necessary. A parent of twin T1D girls in Cambridge is struggling to
maintain the after school program that is independent of the school
board so that the public school board Glucagon policy does not impinge
on his daughters' ability to receive Glucagon. Montessori after school
care guidelines allow for Glucagon. Why does it need to be the Wild
West - a mad Darwinian experiment that sees only the well-connected
survive? While this process is drawn out, we must have one parent at
home with Owen and we have continued to pay for after school care that
we have not used since November for fear that the after school staff
may be our only lifeline to a normal school life for Owen. We have
waited for their monthly board meeting and now we wait for another and
how many more? We have offered to sign a waiver to allow staff to give
Glucagon with a rock solid guarantee from us that we won't sue if our
son's Glucagon injection goes “horribly awry”. That was intended to be
facetious because it is a ridiculous notion. Frankly, I am more likely
to file a lawsuit if someone doesn't try to help my son as he dies.
That was not intended to be facetious.
After speaking to the director of the Catholic School Board, I
followed her recommendation on January 25th to contact another person
who, subsequently, did not reply until today, February 13th when I
learned that there are “protocols” non-Catholics must follow. I have
requested clarification of the protocols and await a reply. I have had
condescending advice from those at UGDSB policy making level that of
course there is always the Glucagon pill - problem solved. Even though
CCAC healthcare personnel were advising in a meeting regarding
Glucagon in the schools, somehow the fact that an injection is only
necessary in the case of an unresponsive/unconscious student was
misplaced in the meeting. The concept of placing anything at all -
particularly a pill or gel that could be choked on - inside the mouth
of an unconscious child is appalling and absolutely not what our
paediatrician advised on our emergency protocol sheet at the school.
He clearly states that in the event of unresponsiveness, call 911 and
administer Glucagon (by injection). Incidentally, I was forced to
amend the section of the emergency protocol sheet where we mention “
911/Glucagon”. It has been bracketed and underlined with my initials
to indicate that when the safety protocol and/or Law are
updated/passed that includes the administering of Glucagon to all T1D
students in need, we will change the notation to include Glucagon. I
sold my soul for that initial and bracketed notation.
As time drags on, Owen is feeling pretty dark about his diagnosis -
life cannot resume as normal. He is caught in this mess of
bureaucratic red tape that makes me ashamed of the people who I
thought put children first.
Best regards,
Beth Mulkins
