A Virginia Senate subcommittee met to review SB1303, a substitute that would consolidate and expand state requirements for diabetes care and management in public schools and school-sponsored activities, Division of Legislative Services staff told the panel.

The measure would require a diabetes medical management plan, or DMMP, signed by the student’s prescriber and parent before certain diabetes services are provided at school; set minimum staffing of so-called level 3 trained diabetes personnel at schools with enrolled students who have diabetes; establish training, documentation and recordkeeping requirements; and add protections and limited civil-immunity language for staff who assist with diabetes care, the Division of Legislative Services analyst, Julia, told the subcommittee.

Why this matters: Students with diabetes require medically accurate, timely care during the school day and at school-sponsored events. The bill’s authors and supporters said codifying a clear process would reduce inconsistent application across school divisions and remove barriers to care; school nurses and school-board representatives warned the measures could create burdens where school nurses are not present and urged clearer implementation paths and attention to training and supervision.

Key provisions summarized by staff

Julia, a Division of Legislative Services analyst, said the substitute consolidates prior code sections into a revised section in Title 22.1 and adds definitions, including "designated receiver," "receiver," and a broad definition of "school setting." The bill would:
- Require a DMMP for any student diagnosed with diabetes whose parent seeks diabetes care or management services in school. The DMMP must be signed by the student's prescriber and parent and may use the American Diabetes Association form or a substantially similar form. The DMMP must be kept where any school nurse, LPN or level 3 trained diabetes personnel can access it.
- Require the Department of Education, in collaboration with the Department of Health, to develop a Virginia DMMP clarification and documentation form; the school would then have 30 days from signing the DMMP to resolve documented concerns.
- Expand the list of diabetes care tasks that students may be permitted to perform independently under parental and prescriber approval; expand who may assist with or provide diabetes services if the school employee is a registered nurse, LPN, advanced practice clinician or a designated level 3 trained diabetes personnel and if prescriber authorization and parental consent are in place.
- Change minimum staffing to require, at any school with at least one enrolled student diagnosed with diabetes, at least three designated level 3 trained diabetes personnel if the school has 10 or more instructional and administrative staff, and at least two for fewer than 10 staff; the substitute increases minimum staffing from current law.
- Move and expand provisions related to undesignated glucagon, including a requirement (in the substitute) that schools maintain at least two doses of undesignated glucagon and keep records of access, administration and disposal.
- Include immunities that limit civil liability for level 3 trained diabetes personnel and certain supervising staff who act in good faith and absent gross negligence or willful misconduct.

Concerns raised by school nurses and school-board representatives

Tracy White, retired school health specialist at the Department of Education, representing school nurses in her remarks, said: "This is a very extensive and in my opinion, a very risky changes to a bill that could create liability for a school division, for an individual person's licensure." White and other nurses said many schools lack a full-time nurse and that some tasks described in the substitute—such as insertion or reinsertion of insulin-pump components or changing infusion sets—are complex, require hands-on competency and supervision, and may be outside nonclinical staff scope or ability to maintain competency.

Robin Gilbert, a Henrico County school-health supervisor speaking in a personal capacity, said: "There is no more admirable part of the nursing profession than that of a school nurse," and cautioned that competency must be verified and maintained through hands-on training and observation.

Stacy Haney, representing the Virginia School Boards Association, said the substitute "includes a massive, massive training requirement for school personnel" and warned that although some training references were made permissive during drafting, requiring a school to implement a DMMP effectively obliges substantial staff training and creates questions about who will perform the tasks and who bears liability.

Support and intent from the bill patron and parents

Senator McPike, the bill’s sponsor, told the panel the measure is intended to remove barriers preventing willing and trained staff from assisting students and to provide clarity for families and schools. "If you have a type 1 kid in your school, the school system can't prohibit someone that meets all those test cases from providing that care," he said, adding the substitute increases clarity and narrows obligations to situations where parental consent, prescriber authorization and staff training are in place.

Peter Noonan, a parent of a child with type 1 diabetes and representative of the Virginia Association of School Superintendents, urged collaboration: "Ensure that the language, that schools are part of the solution as opposed to being shut out of the process," he said, asking that schools be involved in translating the DMMP into an individualized health-care plan usable in the school environment.

A school-nurse perspective supporting caution

Jacqueline McManmon, a registered nurse and certified diabetes care and education specialist who chairs the Virginia Diabetes Council Schools Committee, said she supports the bill’s intent but cautioned that "mandating [the DMMP] use through legislation imposes a burden on both providers and schools and may delay or obstruct care for students whose providers choose not to use that specific format." McManmon also opposed allowing unlicensed personnel to change infusion sets absent ongoing nurse oversight and demonstrated competency.

Distinct procedural and technical questions

Witnesses and subcommittee members discussed: whether training levels 1–3 are already defined in Board of Education guidance (several participants said the levels exist in guidance); whether the DMMP should remain a medical order prepared by the prescriber and then translated by the school into an individualized health-care plan (several speakers stressed that current practice is the school nurse uses the DMMP to create that individualized plan); and how the substitution of permissive language and new staffing minimums would operate where schools lack nurses. Senator Favola suggested focusing on strengthening the individualized health-care plan process and dispute-resolution and education for parents and schools.

Next steps

Members asked for written testimony and produced no formal votes during the hearing. The panel's chair said the subcommittee will hold further meetings and report recommendations to the full committee; the bill also directs the Department of Education, in collaboration with the Department of Health, to prepare training lists, guidance, and to review the diabetes-in-school manual if the substitute becomes law.

Ending note

No formal action or vote was taken at the hearing. Subcommittee members and stakeholders agreed to continue the conversation at future meetings and were asked to submit detailed written comments to the record.