Endo Billing School for 504 Consult

A parent posted in another group that the school nurse called the endo for clarification of the DMMP. The endo had written as a part of the DMMP that all calls were to go to the parents.

The school was billed $250 for a consultation fee because the school nurse called the endo’s office and the endo returned the call. The school demanded the parents pay the bill. Now, there is a battle between the parents and the school because the school called the endo and not the parents, FIRST.

Has anyone else see this practice?

I have had professionals participate in education planning for my son, during the time they spend, I pay for the professional, since I request that they participate. The Rate for the professional was agreed before the service was rendered. The billing was directly to me which I paid my portion, the service was partially paid by my insurance.

Thanks, Joe.

Your situation is different.

The bill in what I was asking was about was endo billing the school for a nurse’s call about a DMMP. The DMMP & its umbrella §504 plan specified the nurse was to contact parent first.

The nurse bypassed the parent & went to the doctor directly. The doctor billed the school $250 as a consultant fee.

The question is, how common is this?

Many years ago my co-worker got a call from her daughter’s school - she was complaining of severe abdominal pain and they were calling an ambulance to take her to hospital. My friend got the bill for the ambulance service.
Even if that does not apply here, fighting this fight might result in ill will - even if unconscious - toward the child; and from what I understand getting schools to care for Type1 kids is daunting enough as it is. $250 may be a small price to pay for peace and harmony between the child (and family) and the school - s/he should not feel uncomfortable about getting the care they need.
In addition I would put in writing that the school will be responsible for fees related to any calls they make to the doctor from now on, with school and parents signing off.
This may be a questuon for an attorney, although that would no doubt cost more than the $250 in dispute.

Thanks @wadawabbit.

Dorie, there are three items of interest I have been scratching on in this one and the US Americans with Disabilities Act (ADA-Law) §504 plans.
[1] a California school would not treat hypoglycemia (CGM alarm) if nurse was on a day off. Nurse worked 2 days per week. Unknown to the parents, the Fire/Rescue (911) had to respond and treat. EMS response bill from the county followed. An Assistant US Attorney (AUSA) for the area did get involved. School now has full time nurses with backup nurses.
[2] Physician had written for school nurse to call parents, FIRST. School nurse flaunted this instruction, leaving the curious to consider, was the bill a way to get back at the nurse?
[3] There is now a ground swell in another social media platform that is having huge success with §504 plans and school nurses & backup staff following CGMs on school devices as a result of several different AUSAs getting involved. Search “Connecticut school CGM follow”.

The key is parents should not need to threated litigation. Schools should willingly comply with Federal law and the DMMP.

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One sad thing is, if they allowed kids to manage lows on their own, this might not have happened…


That is true. The parent in the Fire Rescue paramedics called to give child skittles was because the school district said candy in the possession of a diabetic is medicine. Only district nurses may give medications. Child was self-care at home. School said no K-6 could self manage by policy.

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In some ways things were a lot easier when I was growing up. SMH…

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I may have done a bad job but my point is (and imo) that the onus of payment is on the customer when the customer enters contract and supplier renders product. In the case of the nurse, while they did ask for service, no contract (from the data reported) was presented or implied at the moment service was rendered. So shenanigans on the doctor (raps gavel).

Imagine me invoicing you $1,000 for that little nugget, just because you asked if it was common? :smiley:

@joe , you are correct. The onus is on the nurse for failure to follow instructions even if state nurse practice act & regulations allow the nurse to communicate with the prescriber.

Nurse is obligated to follow the patient’s plan of care.

Great job Joe. Nurse screwed the pooch, so respondent superior, school needs to pay.

Not only that - the school should make the nurse pay.

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This is an interesting area and I’m not sure what the “right” thing is, but just off the top of my head: T1 kids, parents/relatives, friends use insulin, candy, glucagon for low and high treatment of kids without so much as a peep to their doctors; some of them do it remotely using DIY and commercial products. So why does a school system “require” a “nurse” or “medical professional” do this? Yes, if a child is going super low or into DKA, EMS or higher level treatment is going to be called in. But for the standard treatment of a low or high, with in certain parameters (presumably covered in the 504 because we can’t rely on common sense), why can’t school staff, appropriately trained, knowledgeable, always available, but otherwise useable for another school related task take on the role and accomplish the function? Did someone put in the 504 that doesn’t understand?

My reasoning, in addition to the kids/parents do this day in and day out at home, is some schools are having to decide because of funding whether to hire a teacher, a janitor, other needed staff, or more nurses. I realize its been a long time since I was in school and “things” have changed, but I’m not sure we had a full-time nurse, let alone a stand-by nurse, nor what size school would require one or both. I can see a nurse having to be cajoled into other duties or sitting idle a great deal of their time in a smaller school setting. I’ll be glad to be educated on any or all of this… In the mean time, I respect the T1 child’s need for support and that they get it, but I’m not convinced we need a medical professional vice a trained and paid for “extra” duty/knowledge that would suffice the great majority of the time. That said, if other duties DO require the medical professional, by all means lets do it in a responsible fashion.

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@Tlholz , the issue here after a little more scratching around was the nurse was using a caveat of the Nurse Practice Act - nurse may clarify with prescriber.

The prescriber had written, ‘for clarification go thru the parents’ and the nurse failed to follow instructions. On the nurse.

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@987jaj I get that part and appreciate the “clarification”, my first question on that aspect was the ability for a school nurse to obligate the parents contractually for perceived medically un-required actions the nurse took in apparent violation of the 504 guidance to “first contact parents” or similar. Without actually seeing the 504 and “knowing” the facts of who did what, when, and why, there’s insufficient info to address the concern.

However, I still question why schools, absent any legal requirement(s) (admittedly presumed and I may be wrong), depend on a nurse (presumably a medically licensed RN, LPN, NP, etc) when the same T1 child at home get’s monitored/treated (doses of insulin, glucagon, or “medicinal” candy [just…WOW!]) with no required medical skillset? The logic escapes me absent other factors perhaps not stated…but I’m ready to be educated!

@Tlholz , you are correct. The spider web is crazy.

Facts in general.

  1. The DMMP is a signed set of medical orders to the school for the care of a diabetic student.
  2. Absent a nurse, school employees must still act according to the orders. Nowadays, nurses are here.
  3. State nurse & medical practice acts mandate doctors & nurses must clarify ambiguities.

4. Doctor wrote communicate thru parents.
5. Nurse bypassed parents.
6. Nurse called doctor.
7. Doctor wrote involve parents as a) courtesy, b) micro manging nurse, c) prove a point.

8. The nurse called, the doctor billed the school, how common is this?

Points to ponder.
Were doctor & nurse not playing well together & doctor was majorly irritated & thought, “I’ll show the nurse - cha-ching “- send bill.

The original post has disappeared.

I think the reason the doctor wrote “call parents first” is that - at least in my experience - your doctor is not the practitioner to phone in the event of an emergency. My doctors offices have automated answering systems with an outgoing message stating “If this is an emergency, hang up and dial 911.” Urgent as my issue may be, I’ve never had a doctor drop what they were doing to take my call - rather the office promised to give them a message, and I got a call back - several hours later. Much as I would like to speak with the physician who knows me, their number is not the one to call in those circumstances.
Nursey blew it.

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