Kids pay price in medical turf war

Liliana Parker, 8 years old and very cute, happened to be in front of the hippo display Friday morning at the Natural History Museum when it was time to check her blood sugar levels.

“It doesn’t really hurt,” Liliana said when her mother handed her a small finger-pricking and blood analysis device. “You only feel it for, like, two seconds.”

Liliana was diagnosed with Type 1 diabetes at the age of 6, and with no full-time nurse on her Westwood Charter School campus, she has had to learn how to take care of herself. In the Hall of African Mammals, Liliana drew a drop of blood from the tip of her left index finger, placed it on a test strip that slides into her device, then licked the finger clean with a giggle.

A digital monitor gave her a reading that was a bit high, she said, but not a big deal. It was liable to come down a bit before lunch.

Liliana was hanging out at the museum with her two 8-year-old buddies, Ellie Ross and Sebastian Doorhout Mees, who have learned to monitor her behavior and can often tell if her levels are too high or too low. Once, when Liliana’s blood sugar had dipped too low, red-headed Sebastian raced to the school office to get an adult.

It seems like ancient history now, but once upon a time we had nurses on every public school campus in California. Today, the state ranks near the bottom in national nurse-to-student ratios, with one nurse per every 2,200 students, making life more difficult for kids with medical conditions, including an estimated 15,000 with diabetes.

Last year, parents sued the state and forced a settlement in which nonmedical school employees would be trained to administer insulin to diabetic children. But then several nursing organizations filed their own suit, arguing that only medical professionals should be entrusted with such a responsibility. On Nov. 14, a Sacramento County judge ruled in the nurses’ favor.

Liliana’s mother, Greta Parker, was outraged. Of course she’d rather have nurses on campus full time, but trained teachers and aides made for a fair alternative. Now there will be neither.

“I feel like my child is a pawn,” she said.

Jeffrey Ehrlich, a Claremont lawyer and father of a 9-year-old diabetic, was just as steamed.

“I’d love to have a nurse at every school, but the idea that nurses are the only ones that can help diabetic kids manage their health is ridiculous,” he said. “It’s not rocket science.”

His daughter, Elizabeth, has been home-schooled since a scare in kindergarten. Elizabeth’s condition was being managed with an insulin pump, but one day her numbers got out of whack and she felt shaky. With no nurse on campus, she was sent outside to wait for her mother on what was an extremely hot day.

“Her mom saw a group of kids in a circle and our daughter unconscious on the ground,” said Ehrlich, who yanked Elizabeth out of school. He doesn’t want to risk sending her back, but argues that federal law requires accommodations be made for her and other diabetics.

More than 30 states allow nonmedical school employees to administer insulin to students, said a representative of the American Diabetes Assn., which helped engineer the agreement that was overturned earlier this month.

“I happen to believe every school should have a nurse,” said California Supt. of Public Instruction Jack O’Connell. But given budget realities, the compromise to train campus employees made sense, he thought.

Makes sense to me too. And diabetes aside, wouldn’t a full-time nurse mean quicker medical attention for sick kids? Wouldn’t it mean better prevention of communicable diseases and closer monitoring of vision and hearing problems that add to teachers’ challenges?

These are not trick questions. But we all know they won’t be hiring more school nurses any time soon, so here’s a tougher question:

What was the California Nurses Assn. thinking when it fought to prevent non-nurses from administering insulin?

Call me cynical, but it’s hard not to see it as little more than a ploy to protect nursing jobs, even though the CNA does not directly represent school nurses. If teachers and counselors were allowed to manage diabetic children, it might be a license for public education to further deplete the ranks of school nurses.

No way, insists Donna Gerber, CNA director of government relations. She argued that the judge correctly ruled that California’s Nurse Practices Act dictates that only a nurse can handle what can be a complicated job requiring extensive training, so school districts need to find a way to hire more nurses.

“If you make a mistake, it can be fatal,” Gerber said.

So we leave the task to an 8-year-old?

Nonsense, said Dr. Francine Kaufman. Nurses are preferable, she agreed, but not allowing a vice principal or teacher to pinch hit “is holding diabetic children back and imperiling their health,” as well as unnecessarily disrupting their families’ lives.

“We have taught completely illiterate people how to technically deliver insulin,” said Kaufman, telling me it takes about four hours to train an adult.

Kaufman’s credentials aren’t bad, by the way. She’s a former head of the American Diabetes Assn., and she runs the Center for Endocrinology, Diabetes and Metabolism at Childrens Hospital Los Angeles.

At Liliana Parker’s school, a nurse is funded one day a week by the district, and the parents’ booster club pays for two additional days. On the days when there’s no nurse, Greta Parker has to visit the school every two hours to monitor Liliana’s condition.

Greta quit her job as an insurance agent to be free for those visits, field trips and other events.

Just before noon Friday outside the museum, Liliana pricked her finger and got a blood sugar reading that was still a little high.

She often does the insulin injection herself, but she let her mom do it this time in the soft flesh of her left arm.

Did it hurt? I asked.

“Just a pinch, but I don’t really feel it,” Liliana said, and then she joined Sebastian and Ellie for a picnic on the grass.

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steve.lopez@latimes.com